Healthcare Provider Details

I. General information

NPI: 1770719072
Provider Name (Legal Business Name): MRS. LISA D BAIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA D BAIRD PTA

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MANHEIM AVE SUITE 3
BRIDGETON NJ
08302-2136
US

IV. Provider business mailing address

710 CHERRY ST
MILLVILLE NJ
08332-4502
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-9700
  • Fax: 856-455-9791
Mailing address:
  • Phone: 856-327-3157
  • Fax: 856-455-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00075700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: