Provider Demographics
NPI:1770625188
Name:ROLAND-FELTY, LISA MAY (PTA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MAY
Last Name:ROLAND-FELTY
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 1:2109 US HIGHWAY 522 S
Mailing Address - Street 2:
Mailing Address - City:MC VEYTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17051-9429
Mailing Address - Country:US
Mailing Address - Phone:814-542-8630
Mailing Address - Fax:814-542-4970
Practice Address - Street 1:2109 US HIGHWAY 522 S
Practice Address - Street 2:
Practice Address - City:MC VEYTOWN
Practice Address - State:PA
Practice Address - Zip Code:17051-9429
Practice Address - Country:US
Practice Address - Phone:814-542-8630
Practice Address - Fax:814-542-4970
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000981L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396765Medicare ID - Type Unspecified