Provider Demographics
NPI:1770625154
Name:OSTHUS, LISA (CMT, CMMT, CCNT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OSTHUS
Suffix:
Gender:F
Credentials:CMT, CMMT, CCNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 WILLMAR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4738
Mailing Address - Country:US
Mailing Address - Phone:320-231-9878
Mailing Address - Fax:320-222-3972
Practice Address - Street 1:1520 WILLMAR AVE SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4738
Practice Address - Country:US
Practice Address - Phone:320-231-9878
Practice Address - Fax:320-222-3972
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist