Healthcare Provider Details

I. General information

NPI: 1720168008
Provider Name (Legal Business Name): LISA M CAUSGROVE CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E 38TH ST
ERIE PA
16504-1559
US

IV. Provider business mailing address

723 E 41ST ST
ERIE PA
16504-2203
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-8661
  • Fax:
Mailing address:
  • Phone: 814-825-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License NumberYO000248L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: