Individual
MR. MARK JEFFERY LISEMBEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1561 NEWTON AVE, BOWLING GREEN, KY 42104-3238
(270) 842-1611
(270) 842-3858
Mailing address
1561 NEWTON AVE, BOWLING GREEN, KY 42104-3238
(270) 842-1611
(270) 842-3858
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A02788
KY
Other
Enumeration date
07/18/2011
Last updated
05/22/2012
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