Provider Demographics
NPI:1568484491
Name:WEIBERG, LISA ROSE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROSE
Last Name:WEIBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E NICOLLET BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6772
Mailing Address - Country:US
Mailing Address - Phone:952-435-8516
Mailing Address - Fax:763-302-4336
Practice Address - Street 1:501 E NICOLLET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6772
Practice Address - Country:US
Practice Address - Phone:952-435-8516
Practice Address - Fax:763-302-4336
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN793846OtherAMERICA'S PPO
MN962871010735OtherPREFERRED ONE
MN38B38WEOtherBCBS OF MN
MN6403387OtherMEDICA
MNHP44373OtherHEALTHPARTNERS