Healthcare Provider Details

I. General information

NPI: 1508985169
Provider Name (Legal Business Name): LISA BROWELL MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 13TH ST
HUNTINGTON WV
25701-1653
US

IV. Provider business mailing address

6050 E PEA RIDGE RD #202
HUNTINGTON WV
25705-2651
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7622
  • Fax:
Mailing address:
  • Phone: 814-977-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002595
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: