Provider Demographics
NPI:1215814298
Name:EDWARDS, LISA N
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 K ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1413
Mailing Address - Country:US
Mailing Address - Phone:267-516-1425
Mailing Address - Fax:267-516-1425
Practice Address - Street 1:3514 K ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1413
Practice Address - Country:US
Practice Address - Phone:267-516-1425
Practice Address - Fax:267-516-1425
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2139132222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist