Provider Demographics
NPI:1306101720
Name:PIPER, LISA M (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:PIPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:NIETHAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:ORIENTAL
Mailing Address - State:NC
Mailing Address - Zip Code:28571-0894
Mailing Address - Country:US
Mailing Address - Phone:252-249-1051
Mailing Address - Fax:252-249-0112
Practice Address - Street 1:1006 BROAD ST
Practice Address - Street 2:
Practice Address - City:ORIENTAL
Practice Address - State:NC
Practice Address - Zip Code:28571
Practice Address - Country:US
Practice Address - Phone:252-249-1051
Practice Address - Fax:252-249-0112
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist