Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4161 | SC |
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251P0200X | Physical Therapist - Pediatrics | SC |
NPI | 1679034557 |
---|---|
Provider Name | Mrs. Lisa June Pierce |
First Address | Lexington, SC 29072-6401 |
Second Address | Lexington, SC 29072-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 25/03/2019 |