Provider Demographics
NPI:1265536650
Name:WILCOX, LISA L (DPT)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:12365 HURON ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3297
Mailing Address - Country:US
Mailing Address - Phone:720-369-7738
Mailing Address - Fax:303-583-8316
Practice Address - Street 1:12365 HURON ST STE 1800
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3297
Practice Address - Country:US
Practice Address - Phone:720-369-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92592251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC0A103186Medicare UPIN