MEDICARE: MRS. LISE RENEE STOLZE M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4508	CO

General Provider Information

NPI Number	:	1033143201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISE RENEE STOLZE M.P.T.

Provider Business Mailing Address
First Line	:	3773 CHERRY CREEK NORTH DR
Second Line	:	720
City	:	DENVER
State	:	CO
Zip	:	80209-3804
Country	:	US
Telephone Number	:	303-322-9294
Fax Number	:	303-322-9688

Provider Business Practice Location Address
First Line	:	3773 CHERRY CREEK NORTH DR
Second Line	:	720
City	:	DENVER
State	:	CO
Zip	:	80209-3804
Country	:	US
Telephone Number	:	303-322-9294
Fax Number	:	303-322-9688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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