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General NPI Number Information
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NPI Number | 1083985691
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Entity Type | Individual
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Provider Name | LISA LIND HANSEN PTA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 16600 W SPRAGUE RD SUITE 365
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City | MIDDLEBURG HEIGHTS
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State | OH
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Zip | 44130-6318
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Country | US
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Telephone | 216-227-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 3719 EDGEHILL DR
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City | CLEVELAND
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State | OH
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Zip | 44121-1972
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Country | US
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Telephone | 678-438-4570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA06855
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License Number State | OH
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