Provider Demographics
NPI:1831306398
Name:RALSTON, LISA ROSE (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ROSE
Last Name:RALSTON
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 2852
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-1424
Mailing Address - Country:US
Mailing Address - Phone:303-840-1323
Mailing Address - Fax:303-416-4265
Practice Address - Street 1:18700 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9494
Practice Address - Country:US
Practice Address - Phone:303-805-9375
Practice Address - Fax:303-805-9358
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO202896412OtherEIN NUMBER