Provider Demographics
NPI:1891967543
Name:KAZMAR, LISA CHRISTINE (LPTA, LMTA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHRISTINE
Last Name:KAZMAR
Suffix:
Gender:F
Credentials:LPTA, LMTA
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 2227
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-2227
Mailing Address - Country:US
Mailing Address - Phone:505-917-3631
Mailing Address - Fax:505-281-4997
Practice Address - Street 1:1917 OLD HWY 66
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-917-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0575225200000X
NMMT9403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant