Provider Demographics
NPI:1265654073
Name:ALTAMIRANO, LISA CATES (PT MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CATES
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:PT MS
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Mailing Address - Street 1:4851 CAHABA RIVER RD STE 137
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2359
Mailing Address - Country:US
Mailing Address - Phone:205-969-7887
Mailing Address - Fax:205-969-7886
Practice Address - Street 1:4851 CAHABA RIVER RD STE 137
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2359
Practice Address - Country:US
Practice Address - Phone:205-969-7887
Practice Address - Fax:205-969-7886
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH32942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-31990OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL95847Medicare UPIN