Provider Demographics
NPI:1043331747
Name:MASSIE, LISA MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:MASSIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4801 DORSEY HALL DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7763
Mailing Address - Country:US
Mailing Address - Phone:443-393-3788
Mailing Address - Fax:443-378-3533
Practice Address - Street 1:4801 DORSEY HALL DR STE 130
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7763
Practice Address - Country:US
Practice Address - Phone:443-393-3788
Practice Address - Fax:443-378-3533
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209236225100000X
NC11682255A2300X
MD26723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer