Provider Demographics
NPI:1821382136
Name:SWARTZENDRUBER, LISA JAN (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JAN
Last Name:SWARTZENDRUBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5239
Mailing Address - Country:US
Mailing Address - Phone:248-844-9168
Mailing Address - Fax:
Practice Address - Street 1:1350 KIRTS BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4851
Practice Address - Country:US
Practice Address - Phone:248-244-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist