Individual
MRS. LISA ANN FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1712 N LELAND DR, HUNTINGBURG, IN 47542-9348
(812) 683-4090
Mailing address
1712 N LELAND DR, HUNTINGBURG, IN 47542-9348
(812) 683-4090
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007367A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05007367A
PT LICENSE NUMBER
IN
Enumeration date
04/29/2010
Last updated
04/29/2010
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