Provider Demographics
NPI:1881187193
Name:AMES, LISA NICOLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:AMES
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2320
Mailing Address - Country:US
Mailing Address - Phone:812-585-1394
Mailing Address - Fax:
Practice Address - Street 1:398 S 23RD ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803
Practice Address - Country:US
Practice Address - Phone:812-462-4396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2021-12-23
Deactivation Date:2021-03-04
Deactivation Code:
Reactivation Date:2021-12-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer