Individual
LISA OSTERBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
8726 US 42, FLORENCE, KY 41042-9625
(859) 301-2663
(859) 817-7848
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 817-7848
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
002745
OH
2255A2300X
Athletic Trainer
972
KY
363A00000X
Physician Assistant
50.004115
OH
363AM0700X
Medical Physician Assistant
50.004115
OH
363AM0700X
Medical Physician Assistant
Primary
PA2049
KY
363AS0400X
Surgical Physician Assistant
50.004115
OH
Other
Enumeration date
12/29/2009
Last updated
08/23/2018
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