Provider Demographics
NPI:1750511325
Name:NEWMAN, LISA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 LAKE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-3059
Mailing Address - Country:US
Mailing Address - Phone:912-717-0077
Mailing Address - Fax:
Practice Address - Street 1:153 LAKE VIEW CIR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-3059
Practice Address - Country:US
Practice Address - Phone:912-717-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist