Provider Demographics
NPI:1609116185
Name:LIED, JO ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:LIED
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:PO BOX 4757
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-4757
Mailing Address - Country:US
Mailing Address - Phone:719-660-2675
Mailing Address - Fax:
Practice Address - Street 1:2490 JENNER CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3547
Practice Address - Country:US
Practice Address - Phone:719-425-7771
Practice Address - Fax:303-223-0084
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics