Provider Demographics
NPI:1982948261
Name:ASBURY, LISA RENEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:ASBURY
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 1:253 SCARLETT DR
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-4722
Mailing Address - Country:US
Mailing Address - Phone:865-617-5846
Mailing Address - Fax:423-562-1005
Practice Address - Street 1:136 DAVIS LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3118
Practice Address - Country:US
Practice Address - Phone:865-617-5846
Practice Address - Fax:423-562-1005
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2787225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant