Provider Demographics
NPI:1609163690
Name:RICHARDS, LISA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:RICHARDS
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 1:2748 COLONIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4947
Mailing Address - Country:US
Mailing Address - Phone:406-443-1122
Mailing Address - Fax:406-443-1144
Practice Address - Street 1:2748 COLONIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4947
Practice Address - Country:US
Practice Address - Phone:406-443-1122
Practice Address - Fax:406-443-1144
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist