Provider Demographics
NPI:1255538799
Name:HYMES, LISA C (MSPT, DPT, PCS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:C
Last Name:HYMES
Suffix:
Gender:F
Credentials:MSPT, DPT, PCS
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:C
Other - Last Name:AGNEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1027 TURNBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9594
Mailing Address - Country:US
Mailing Address - Phone:303-870-9302
Mailing Address - Fax:303-433-1574
Practice Address - Street 1:1027 TURNBERRY CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9594
Practice Address - Country:US
Practice Address - Phone:303-870-9302
Practice Address - Fax:303-433-1574
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49233319Medicaid