Healthcare Provider Details

I. General information

NPI: 1720991318
Provider Name (Legal Business Name): LISA PIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 OLD STATE RD
BRANDENBURG KY
40108-1608
US

IV. Provider business mailing address

2585 MOLLY BROWN ROAD
BRANDENBURG KY
40108-1608
US

V. Phone/Fax

Practice location:
  • Phone: 270-668-3282
  • Fax:
Mailing address:
  • Phone: 270-668-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number301858
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: