Provider Demographics
NPI:1861038085
Name:KHAN, LISA MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:KHAN
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 1:9442 ELMHURST LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2597
Mailing Address - Country:US
Mailing Address - Phone:720-318-4097
Mailing Address - Fax:
Practice Address - Street 1:6325 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2914
Practice Address - Country:US
Practice Address - Phone:720-592-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist