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General NPI Number Information
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NPI Number | 1417250424
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Entity Type | Individual
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Provider Name | LISA M. PERRY MT, PTA
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Gender | Female
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 975 N LINCOLN ST SUITE 202
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City | DENVER
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State | CO
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Zip | 80203-2725
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Country | US
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Telephone | 303-861-6632
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Fax |
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Provider Business Mailing Address
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Address Line | 975 N LINCOLN ST SUITE 202
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City | DENVER
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State | CO
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Zip | 80203-2725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0015599
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.0012283
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License Number State | CO
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