Provider Demographics
NPI:1043805294
Name:KONSTANDT, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KONSTANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 J N PEASE PL STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4527
Mailing Address - Country:US
Mailing Address - Phone:704-817-8230
Mailing Address - Fax:
Practice Address - Street 1:1977 J N PEASE PL STE 203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4527
Practice Address - Country:US
Practice Address - Phone:704-817-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist