Lisa Custer, PHD, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A0001128 Issued in MD

Practice address

306 Dixie Dr
Towson, MD 21204-7001

Phone

(219) 309-4121

NPI assigned

Jun 10, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Lisa Chinn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1518305879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 DIXIE DR",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212047001",
            "telephone_number": "219-309-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 DIXIE DR",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212047001",
            "telephone_number": "219-309-4121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "639 Hollibaugh Ave",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "443103928",
            "country_code": "US",
            "telephone_number": "219-309-4121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUSTER",
        "first_name": "LISA",
        "credential": "PHD, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-10",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT004080",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MD",
            "license": "A0001128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "CHINN",
            "credential": "PHD, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Alexa Curtis, LCSW-C
• Carey Custer
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• Athletic Trainer in Towson, MD
• Providers in Towson, MD by specialty
• Athletic Trainer in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.