Individual
MRS. LISA MICHELLE SAXE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, MTC
Contact information
Practice address
9602 COLDWATER RD, SUITE 102, FORT WAYNE, IN 46825-2095
(260) 489-9887
Mailing address
9602 COLDWATER RD, SUITE 102, FORT WAYNE, IN 46825-2095
(260) 489-9887
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007104A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000300155
ANTHEM
IN
01
—
102072957
DOL
IN
05
—
200455240
—
IN
01
—
382617193732
TRICARE
IN
Enumeration date
09/28/2006
Last updated
11/08/2010
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