Provider Demographics
NPI:1144561283
Name:DOLLAR, LISSA ANNAMARIE (PTA)
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:ANNAMARIE
Last Name:DOLLAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19170 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80928-9432
Mailing Address - Country:US
Mailing Address - Phone:719-464-4861
Mailing Address - Fax:
Practice Address - Street 1:19170 POWERS RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80928-9432
Practice Address - Country:US
Practice Address - Phone:719-464-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012838225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0012838OtherMEDICARE