Provider Demographics
NPI:1154858074
Name:MONTALDO, LISA BOOS (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BOOS
Last Name:MONTALDO
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 1:2901 RIDGELAKE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4934
Mailing Address - Country:US
Mailing Address - Phone:504-309-0868
Mailing Address - Fax:504-309-0867
Practice Address - Street 1:2901 RIDGELAKE DR STE 209
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4934
Practice Address - Country:US
Practice Address - Phone:504-309-0868
Practice Address - Fax:504-309-0867
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00698OtherLOUISIANA PHYSICAL THERAPY BOARD