Healthcare Provider Details

I. General information

NPI: 1144451832
Provider Name (Legal Business Name): LISA OGONOWSKI HARLAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 LAWRENCEVILLE HWY
TUCKER GA
30084-1930
US

IV. Provider business mailing address

5844 LAWRENCEVILLE HWY
TUCKER GA
30084-1930
US

V. Phone/Fax

Practice location:
  • Phone: 770-925-9170
  • Fax:
Mailing address:
  • Phone: 770-925-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: