Provider Demographics
NPI:1184905713
Name:HARPER, LISA (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HARPER
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 1:501 EMERSON LN
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7004
Mailing Address - Country:US
Mailing Address - Phone:985-778-8984
Mailing Address - Fax:
Practice Address - Street 1:2565 FLORIDA ST STE 4&5
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3566
Practice Address - Country:US
Practice Address - Phone:985-243-1219
Practice Address - Fax:985-626-6966
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021602251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA02160OtherPHYSICAL THERAPY LICENSE
LA1184905713Medicaid