Healthcare Provider Details

I. General information

NPI: 1184905713
Provider Name (Legal Business Name): LISA HARPER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 08/22/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 FLORIDA ST STE 4&5
MANDEVILLE LA
70448-3566
US

IV. Provider business mailing address

501 EMERSON LN
MANDEVILLE LA
70448-7004
US

V. Phone/Fax

Practice location:
  • Phone: 985-243-1219
  • Fax: 985-626-6966
Mailing address:
  • Phone: 985-778-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02160
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number02160
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: