Healthcare Provider Details

I. General information

NPI: 1215966106
Provider Name (Legal Business Name): LISA KAY ANTHONY PT,MSPT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 HIXSON PIKE
HIXSON TN
37343-5039
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 615-614-8833
  • Fax:
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-805-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000003318
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT0000003318
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: