Provider Demographics
NPI:1033108212
Name:HANNES, LISA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:HANNES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4626
Mailing Address - Country:US
Mailing Address - Phone:414-643-8793
Mailing Address - Fax:
Practice Address - Street 1:3033 W LAYTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2628
Practice Address - Country:US
Practice Address - Phone:414-647-0033
Practice Address - Fax:414-647-0079
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6015-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist