Provider Demographics
NPI:1134541535
Name:KERR, LISA (PTA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:KERR
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 1:8109 S BURLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-9646
Mailing Address - Country:US
Mailing Address - Phone:765-749-5512
Mailing Address - Fax:
Practice Address - Street 1:8109 S BURLINGTON DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-9646
Practice Address - Country:US
Practice Address - Phone:765-749-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004471A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant