Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 17802 | MD |
NPI | 1003196486 |
---|---|
Provider Name | Mrs. Lisa Baskins |
First Address | Lanham, MD 20706-3511 |
Second Address | Largo, MD 20774-3705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2011 |
Last Update Date | 25/07/2013 |