Healthcare Provider Details

I. General information

NPI: 1033527916
Provider Name (Legal Business Name): LISA GEPFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 GERALD DR
ELIZABETHTOWN PA
17022-1765
US

IV. Provider business mailing address

28 GERALD DR
ELIZABETHTOWN PA
17022-1765
US

V. Phone/Fax

Practice location:
  • Phone: 717-572-3890
  • Fax:
Mailing address:
  • Phone: 717-572-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI000740
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000773
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: