Healthcare Provider Details

I. General information

NPI: 1609114529
Provider Name (Legal Business Name): LISA SANDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E OREGON RD
LITITZ PA
17543-9205
US

IV. Provider business mailing address

115 MARKET ST APT 2
PITTSTON PA
18640-2559
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-3271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE009615
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: