Healthcare Provider Details

I. General information

NPI: 1700018280
Provider Name (Legal Business Name): LISA JEAN MARTENS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 PRIOR AVE N STE 235E
SAINT PAUL MN
55104-1254
US

IV. Provider business mailing address

4801 W 81ST ST STE 103
BLOOMINGTON MN
55437-1111
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-8083
  • Fax: 651-645-8078
Mailing address:
  • Phone: 952-924-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8380
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8380
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: