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General NPI Number Information
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NPI Number | 1891967543
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Entity Type | Individual
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Provider Name | LISA CHRISTINE KAZMAR LPTA, LMTA
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Gender | Female
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 1917 OLD HWY 66
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City | EDGEWOOD
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State | NM
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Zip | 87015
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Country | US
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Telephone | 505-917-3631
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2227
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City | EDGEWOOD
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State | NM
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Zip | 87015-2227
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Country | US
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Telephone | 505-917-3631
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Fax | 505-281-4997
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-0575
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT9403
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License Number State | NM
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