Provider Demographics
NPI:1043481062
Name:GROSSMAN, LISA LEE (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:GROSSMAN
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 1:124 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-9421
Mailing Address - Country:US
Mailing Address - Phone:406-466-3040
Mailing Address - Fax:406-466-3050
Practice Address - Street 1:124 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:CHOTEAU
Practice Address - State:MT
Practice Address - Zip Code:59422-9421
Practice Address - Country:US
Practice Address - Phone:406-466-3040
Practice Address - Fax:406-466-3050
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist