Provider Demographics
NPI:1720259120
Name:LAFLEUR, LISA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:LAFLEUR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 COLLINS AVE
Mailing Address - Street 2:PO BOX 5510
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3002
Mailing Address - Country:US
Mailing Address - Phone:701-663-9531
Mailing Address - Fax:
Practice Address - Street 1:309 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3002
Practice Address - Country:US
Practice Address - Phone:701-663-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1065OtherLICENSE