Provider Demographics
NPI:1578582235
Name:RICHARDSON, LISA CROSBY (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CROSBY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELIZABETH
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:7373 FRANCE AVE S
Practice Address - Street 2:SUITE 312
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4534
Practice Address - Country:US
Practice Address - Phone:952-832-0076
Practice Address - Fax:952-832-0477
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
131H8CROtherBLUE CROSS BLUE SHIELD
HP66875OtherHEALTHPARTNERS
6406657OtherMEDICA
969991030949OtherPREFERREDONE