Provider Demographics
NPI:1801124680
Name:FLEMING, LISA CAROL (PTA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CAROL
Last Name:FLEMING
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 1:22701 MAYFAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-9484
Mailing Address - Country:US
Mailing Address - Phone:330-705-9411
Mailing Address - Fax:
Practice Address - Street 1:3015 17TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-6004
Practice Address - Country:US
Practice Address - Phone:330-452-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 05913225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant