Individual
TERESA LYNN LISUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5261 BROADWAY AVE, NEWTON FALLS, OH 44444-1893
(330) 307-7296
Mailing address
5261 BROADWAY AVE, NEWTON FALLS, OH 44444-1893
(330) 307-7296
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/30/2019
Last updated
11/30/2019
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