Provider Demographics
NPI:1720221724
Name:BURCH, LISA KAY
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:BURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:COLBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:943 PINE LOG RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7330
Mailing Address - Country:US
Mailing Address - Phone:803-649-9797
Mailing Address - Fax:803-642-2759
Practice Address - Street 1:943 PINE LOG RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803
Practice Address - Country:US
Practice Address - Phone:803-649-9797
Practice Address - Fax:803-642-2759
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist