Healthcare Provider Details

I. General information

NPI: 1679956825
Provider Name (Legal Business Name): LISA A ZILLER RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MIDDLE AVE
BLOOMSBURG PA
17815-2510
US

IV. Provider business mailing address

6 MIDDLE AVE
BLOOMSBURG PA
17815-2510
US

V. Phone/Fax

Practice location:
  • Phone: 570-204-3798
  • Fax:
Mailing address:
  • Phone: 570-204-3798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279S1500X
TaxonomySNF/Subacute Care Registered Respiratory Therapist
License NumberYM004806L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: