Provider Demographics
NPI:1750768982
Name:LAUER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LAUER
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 1:730 MAIN ST
Mailing Address - Street 2:APT C2
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3850
Mailing Address - Country:US
Mailing Address - Phone:610-324-2031
Mailing Address - Fax:
Practice Address - Street 1:220 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3805
Practice Address - Country:US
Practice Address - Phone:610-324-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist