Provider Demographics
NPI:1407047467
Name:MATHESON, LISA M (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MATHESON
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Gender:F
Credentials:PT
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:3366 OAKDALE AVE N
Practice Address - Street 2:SUITE 103
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-520-7870
Practice Address - Fax:763-520-7580
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2012-09-18
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Provider Licenses
StateLicense IDTaxonomies
MN60352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic