Individual
LISA PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1600 SAINT PARIS PIKE, SPRINGFIELD, OH 45504-1226
(937) 399-8131
Mailing address
9562 LOVELESS RD, MECHANICSBURG, OH 43044-9535
(937) 631-7249
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
08517
OH
Other
Enumeration date
11/22/2013
Last updated
11/22/2013
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