Provider Demographics
NPI:1801443684
Name:WOOD, LISA KATHRYN (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KATHRYN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630001
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80163-0001
Mailing Address - Country:US
Mailing Address - Phone:303-660-6493
Mailing Address - Fax:303-346-9727
Practice Address - Street 1:8853 WAGNER CT
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5244
Practice Address - Country:US
Practice Address - Phone:303-660-6493
Practice Address - Fax:303-660-6493
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.00146802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics