Provider Demographics
NPI:1588153399
Name:LOWE, LISA D (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:LOWE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DOMINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4000 W 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-3613
Mailing Address - Country:US
Mailing Address - Phone:913-221-8656
Mailing Address - Fax:
Practice Address - Street 1:4000 W 102ND ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-3613
Practice Address - Country:US
Practice Address - Phone:913-221-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR10902251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics