Provider Demographics
NPI:1003805821
Name:BRUECKNER, LISA INGER (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:INGER
Last Name:BRUECKNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:INGER
Other - Last Name:LAMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:720-754-4710
Mailing Address - Fax:303-699-3112
Practice Address - Street 1:14000 E ARAPAHOE RD
Practice Address - Street 2:SUITE 370
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4043
Practice Address - Country:US
Practice Address - Phone:720-754-4710
Practice Address - Fax:303-699-3112
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist