Individual
LISA ANN WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8638 VETERANS HWY, 1ST FLOOR, MILLERSVILLE, MD 21108-1422
(410) 729-4508
(410) 429-4526
Mailing address
PO BOX 15945, BELFAST, ME 04915-4054
(410) 729-4508
(410) 729-4526
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
26130
MD
225100000X
Physical Therapist
PT3884
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502205300
—
MD
Enumeration date
04/17/2006
Last updated
01/18/2017
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