Healthcare Provider Details

I. General information

NPI: 1003196486
Provider Name (Legal Business Name): LISA BASKINS M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 LARGO CENTER DR
LARGO MD
20774-3705
US

IV. Provider business mailing address

8200 GOOD LUCK RD
LANHAM MD
20706-3511
US

V. Phone/Fax

Practice location:
  • Phone: 301-233-6675
  • Fax:
Mailing address:
  • Phone: 301-552-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17802
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: