Provider Demographics
NPI:1396029609
Name:BUCHHOLZ, LISA (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SAUCIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:3501 DUNN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6762
Mailing Address - Country:US
Mailing Address - Phone:314-839-5994
Mailing Address - Fax:
Practice Address - Street 1:3501 DUNN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6762
Practice Address - Country:US
Practice Address - Phone:314-839-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007006871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist