Provider Demographics
NPI:1538225958
Name:HOLDER, LISA TASSIE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:TASSIE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:TASSIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSPT
Mailing Address - Street 1:8205 PRESIDENTS DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8621
Mailing Address - Country:US
Mailing Address - Phone:717-839-2125
Mailing Address - Fax:717-565-1104
Practice Address - Street 1:1948 DECHERD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3875
Practice Address - Country:US
Practice Address - Phone:931-313-5560
Practice Address - Fax:931-313-5339
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist