Provider Demographics
NPI:1710953328
Name:MCINTOSH, LISA B (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:738 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5238
Mailing Address - Country:US
Mailing Address - Phone:252-635-2676
Mailing Address - Fax:252-633-2577
Practice Address - Street 1:128 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-353-4500
Practice Address - Fax:910-353-5610
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC10049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2508962Medicare PIN