Provider Demographics
NPI:1467754440
Name:ANGLISS, LISA LYNN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:ANGLISS
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 1:1820 NEWLAND CT APT 317
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1486
Mailing Address - Country:US
Mailing Address - Phone:970-403-7481
Mailing Address - Fax:
Practice Address - Street 1:600 GRANT ST
Practice Address - Street 2:SUITE 350
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3524
Practice Address - Country:US
Practice Address - Phone:303-309-6704
Practice Address - Fax:720-287-3432
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist