Provider Demographics
NPI:1518325406
Name:AVERNA, LISA (CMT, LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:AVERNA
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 ALBION ST APT 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-4452
Mailing Address - Country:US
Mailing Address - Phone:303-903-4854
Mailing Address - Fax:
Practice Address - Street 1:4040 ALBION ST APT 205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-4452
Practice Address - Country:US
Practice Address - Phone:303-903-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist