Provider Demographics
NPI:1588439749
Name:BURCH-HARNEY, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BURCH-HARNEY
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 1:8634 HAYSHED LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2604
Mailing Address - Country:US
Mailing Address - Phone:443-829-2674
Mailing Address - Fax:
Practice Address - Street 1:8450 BALTIMORE NATIONAL PIKE, #165
Practice Address - Street 2:SUITE 406
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-2104
Practice Address - Country:US
Practice Address - Phone:443-447-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR03294225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty