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NPI Code Detail

MEDICARE: LISA SLOAN MPT

MEDICARE: LISA SLOAN MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical TherapistPT010049LPA
2225100000XPhysical TherapistP21364NC

General Provider Information

NPI Number : 1376696377
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA SLOAN MPT
Provider Business Mailing Address
First Line : 2300 GALLBERRY LN
Second Line :
City : WAXHAW
State : NC
Zip : 28173-0161
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2300 GALLBERRY LN
Second Line :
City : WAXHAW
State : NC
Zip : 28173-0161
Country : US
Telephone Number : 610-562-6926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2007
Last Update Date : 06/23/2025

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