Provider Demographics
NPI:1427597400
Name:DANNEMILLER, LISA
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:DANNEMILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 E 17TH AVE
Mailing Address - Street 2:PHYSICAL THERAPY PROGRAM MAIL STOP C244
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2535
Mailing Address - Country:US
Mailing Address - Phone:303-724-9598
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL00075192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics