Provider Demographics
NPI:1760813968
Name:STOBIERSKI, LISA (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:STOBIERSKI
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAPLE AVE W
Mailing Address - Street 2:APT 304
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1051
Mailing Address - Country:US
Mailing Address - Phone:216-337-5700
Mailing Address - Fax:
Practice Address - Street 1:301 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1899
Practice Address - Country:US
Practice Address - Phone:216-337-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer