Provider Demographics
NPI:1780914648
Name:FROBERG, LISA MARY (DPT, MPT)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MARY
Last Name:FROBERG
Suffix:
Gender:F
Credentials:DPT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11853 T. ROAD
Mailing Address - Street 2:
Mailing Address - City:RAPID RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49878
Mailing Address - Country:US
Mailing Address - Phone:361-318-2398
Mailing Address - Fax:
Practice Address - Street 1:551 HILL COUNTRY DRIVE
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-258-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183210172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist