Provider Demographics
NPI:1518122456
Name:LOSTETTER, ELIZABETH C (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:LOSTETTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1170 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6403
Mailing Address - Country:US
Mailing Address - Phone:651-491-4293
Mailing Address - Fax:651-730-7772
Practice Address - Street 1:731 BIELENBERG DR STE 107
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1701
Practice Address - Country:US
Practice Address - Phone:651-730-7771
Practice Address - Fax:651-730-7772
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650002717OtherMEDICARE PTAN