Provider Demographics
NPI:1720669146
Name:LISA NIELSEN-WHITE, PT, DPT, PLLC
Entity Type:Organization
Organization Name:LISA NIELSEN-WHITE, PT, DPT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:402-965-1670
Mailing Address - Street 1:14439 275TH ST
Mailing Address - Street 2:
Mailing Address - City:TREYNOR
Mailing Address - State:IA
Mailing Address - Zip Code:51575-7266
Mailing Address - Country:US
Mailing Address - Phone:402-965-1670
Mailing Address - Fax:
Practice Address - Street 1:14439 275TH ST
Practice Address - Street 2:
Practice Address - City:TREYNOR
Practice Address - State:IA
Practice Address - Zip Code:51575-7266
Practice Address - Country:US
Practice Address - Phone:402-965-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty