Provider Demographics
NPI:1770719072
Name:BAIRD, LISA D
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:BAIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:710 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4502
Mailing Address - Country:US
Mailing Address - Phone:856-327-3157
Mailing Address - Fax:856-455-9700
Practice Address - Street 1:70 MANHEIM AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2136
Practice Address - Country:US
Practice Address - Phone:856-455-9700
Practice Address - Fax:856-455-9791
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00075700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-6704Medicare PIN