Individual
REBECCA LISAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2007 CHESTNUT ST, SUITE 1, PHILADELPHIA, PA 19103-3318
(267) 235-4759
Mailing address
2046 PINE ST, PHILADELPHIA, PA 19103-6536
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MSG004828
PA
Other
Enumeration date
12/01/2014
Last updated
12/01/2014
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