Provider Demographics
NPI:1962686717
Name:WESTLAKE, LISA REDLIN (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:REDLIN
Last Name:WESTLAKE
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 1:4733 SUMMERSET DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9203
Mailing Address - Country:US
Mailing Address - Phone:605-343-9478
Mailing Address - Fax:605-343-9478
Practice Address - Street 1:4733 SUMMERSET DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9203
Practice Address - Country:US
Practice Address - Phone:605-343-9478
Practice Address - Fax:605-343-9478
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD40157Medicare PIN