Provider Demographics
NPI:1407289754
Name:HOIUM, LISA (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HOIUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 GOLDEN VALLEY RD
Mailing Address - Street 2:BOX 1315
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4457
Mailing Address - Country:US
Mailing Address - Phone:218-310-3739
Mailing Address - Fax:
Practice Address - Street 1:5700 BOTTINEAU BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3183
Practice Address - Country:US
Practice Address - Phone:763-535-7607
Practice Address - Fax:763-535-7649
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist