Provider Demographics
NPI:1023190121
Name:LUND, MARA LYNN (LPT)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:LYNN
Last Name:LUND
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 GARDEN CTR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1730
Mailing Address - Country:US
Mailing Address - Phone:303-465-0084
Mailing Address - Fax:303-465-0584
Practice Address - Street 1:54 GARDEN CTR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1730
Practice Address - Country:US
Practice Address - Phone:303-465-0084
Practice Address - Fax:303-465-0584
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805201Medicare PIN