Provider Demographics
NPI:1790559946
Name:ANDREWS, LISA S (PTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12957 LEWISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:MD
Mailing Address - Zip Code:21625-2121
Mailing Address - Country:US
Mailing Address - Phone:410-924-9565
Mailing Address - Fax:
Practice Address - Street 1:1630 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2791
Practice Address - Country:US
Practice Address - Phone:443-481-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3569225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant