Provider Demographics
NPI:1700018280
Name:MARTENS, LISA JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JEAN
Last Name:MARTENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10900 73RD AVE N
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5458
Mailing Address - Country:US
Mailing Address - Phone:763-315-1296
Mailing Address - Fax:763-315-1297
Practice Address - Street 1:2334 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 170
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1858
Practice Address - Country:US
Practice Address - Phone:651-645-8083
Practice Address - Fax:651-645-8078
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN8380225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic