1689659633 NPI number — DR. LISA PERKINS HOUCK PT, DPT, OCS, MTC

Table of content: DR. LISA PERKINS HOUCK PT, DPT, OCS, MTC (NPI 1689659633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689659633 NPI number — DR. LISA PERKINS HOUCK PT, DPT, OCS, MTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUCK
Provider First Name:
LISA
Provider Middle Name:
PERKINS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, OCS, MTC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERKINS
Provider Other First Name:
LISA
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, OCS, MTC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689659633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 SOLAREX CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21703-8624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-215-9023
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 SOLAREX CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703-8624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-215-9023
Provider Business Practice Location Address Fax Number:
240-215-9026
Provider Enumeration Date:
12/13/2005

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: 208100000X , with the licence number:  20195 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 147719000 . This is a "DOL FSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2116439 . This is a "MAMSI FSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3116439 . This is a "MAMSI MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 334552 . This is a "PHCS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 611844-02 . This is a "CAREFIRST MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K134-0001 . This is a "BC FEP MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 650022015 . This is a "MC RR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6611844-01 . This is a "CAREFIRST FSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 602030700 . This is a "DOL MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R5590004 . This is a "FSS BC FEP" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".




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