Provider Demographics
NPI:1689911679
Name:HASSEBROCK, LISA MAUREEN (NCTMB, LMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MAUREEN
Last Name:HASSEBROCK
Suffix:
Gender:F
Credentials:NCTMB, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 UNIVERSITY AVE W STE 224
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1511
Mailing Address - Country:US
Mailing Address - Phone:612-290-4527
Mailing Address - Fax:
Practice Address - Street 1:2395 UNIVERSITY AVE W STE 224
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1511
Practice Address - Country:US
Practice Address - Phone:612-290-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist