Provider Demographics
NPI:1932595501
Name:SPIES, LISA A (ATC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:SPIES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:SPIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:120 S 675 W
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-9720
Mailing Address - Country:US
Mailing Address - Phone:520-840-3082
Mailing Address - Fax:
Practice Address - Street 1:120 S 675 W
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-9720
Practice Address - Country:US
Practice Address - Phone:520-840-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer