Provider Demographics
NPI:1043523889
Name:DUERLER, LISA DIANE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:DUERLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 DESDEMONA WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1344
Mailing Address - Country:US
Mailing Address - Phone:859-296-9588
Mailing Address - Fax:
Practice Address - Street 1:324 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1402
Practice Address - Country:US
Practice Address - Phone:859-797-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist