Healthcare Provider Details

I. General information

NPI: 1881991735
Provider Name (Legal Business Name): LISA ERTLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BUCHANAN DPT

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CLEAVER FARMS RD STE 1
MIDDLETOWN DE
19709-1670
US

IV. Provider business mailing address

210 CLEAVER FARMS RD STE 1
MIDDLETOWN DE
19709-1670
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-2048
  • Fax:
Mailing address:
  • Phone: 302-449-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002669
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: