Provider Demographics
NPI:1043412083
Name:SYMONS, LISA MARIE (OTR)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SYMONS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:KONESKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 CANDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7104
Mailing Address - Country:US
Mailing Address - Phone:724-933-0214
Mailing Address - Fax:
Practice Address - Street 1:371 BETHEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-2074
Practice Address - Country:US
Practice Address - Phone:724-593-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004838L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist