Provider Demographics
NPI:1952660797
Name:HAMILTON, LISA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 BLUE MOUNTAIN RD
Mailing Address - Street 2:SUITE 6L
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9213
Mailing Address - Country:US
Mailing Address - Phone:406-251-2323
Mailing Address - Fax:406-251-2999
Practice Address - Street 1:5000 BLUE MOUNTAIN RD
Practice Address - Street 2:SUITE 6L
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-9213
Practice Address - Country:US
Practice Address - Phone:406-251-2323
Practice Address - Fax:406-251-2999
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT11228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist