Provider Demographics
NPI:1700289485
Name:KNOCH, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KNOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 BUCKEYE DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2655
Mailing Address - Country:US
Mailing Address - Phone:419-238-0384
Mailing Address - Fax:419-238-2137
Practice Address - Street 1:1120 BUCKEYE DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2655
Practice Address - Country:US
Practice Address - Phone:419-238-0384
Practice Address - Fax:419-238-2137
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5822225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant