Healthcare Provider Details

I. General information

NPI: 1760953640
Provider Name (Legal Business Name): LISA PRANNO PT, DPT, GCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CASTLE CREEK RD
ASPEN CO
81611-1159
US

IV. Provider business mailing address

11 ASPEN VLG
ASPEN CO
81611-9646
US

V. Phone/Fax

Practice location:
  • Phone: 970-544-1177
  • Fax: 970-544-1544
Mailing address:
  • Phone: 970-710-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8484
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: