Provider Demographics
NPI:1871992354
Name:MARTINEZ, LISA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55003-1159
Mailing Address - Country:US
Mailing Address - Phone:702-400-6808
Mailing Address - Fax:
Practice Address - Street 1:1715 TOWER DR W STE 330
Practice Address - Street 2:LAKEVIEW HOMECARE & HOSPICE
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7608
Practice Address - Country:US
Practice Address - Phone:651-430-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist