Provider Demographics
NPI:1801239116
Name:KERN, LISA (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9168 S 450 W
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47665-9125
Mailing Address - Country:US
Mailing Address - Phone:812-202-1259
Mailing Address - Fax:
Practice Address - Street 1:251 HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:IN
Practice Address - Zip Code:47631-9075
Practice Address - Country:US
Practice Address - Phone:812-682-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003294A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant