MEDICARE: LISA BARNES PTA

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
1	225200000X	Physical Therapy Assistant	5502003601	MI

General Provider Information

NPI Number	:	1417380635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BARNES PTA

Provider Business Mailing Address
First Line	:	1525 W MAUMEE ST
Second Line	:	SUITE 3
City	:	ADRIAN
State	:	MI
Zip	:	49221-1899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 W MAUMEE ST
Second Line	:	SUITE 3
City	:	ADRIAN
State	:	MI
Zip	:	49221-1899
Country	:	US
Telephone Number	:	517-265-6007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	08/12/2013

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Directions to “ LISA BARNES PTA” Practice Location

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