Provider Demographics
NPI:1518177757
Name:BOSTICK, LISA MARIE (MS ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ATC
Mailing Address - Street 1:2231 REMINGTON WAY APT 105
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5415
Mailing Address - Country:US
Mailing Address - Phone:406-548-7232
Mailing Address - Fax:
Practice Address - Street 1:1871 S 22ND AVE STE 2B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7054
Practice Address - Country:US
Practice Address - Phone:406-548-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer