Provider Demographics
NPI:1972876597
Name:DISHER, KAROL L (LMT)
Entity Type:Individual
Prefix:MS
First Name:KAROL
Middle Name:L
Last Name:DISHER
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 1:335 EASTERN SHORES DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-1215
Mailing Address - Country:US
Mailing Address - Phone:731-968-9206
Mailing Address - Fax:
Practice Address - Street 1:459 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1431
Practice Address - Country:US
Practice Address - Phone:731-968-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47493172M00000X, 225700000X
TNMT 0000006204172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist