1366690786 NPI number — MRS. LISA R SWEET PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366690786 NPI number — MRS. LISA R SWEET PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEET
Provider First Name:
LISA
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RENNA
Provider Other First Name:
LISA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366690786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 TREMONT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNINGTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19335-4131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-269-3774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 CG ZINN ROAD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
THORNDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-383-7700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PT019349 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)