Provider Demographics
NPI:1841279742
Name:RAYMOND, LISA LYNN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 TALISMAN DR
Mailing Address - Street 2:UNIT D4
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-731-1888
Mailing Address - Fax:970-731-1889
Practice Address - Street 1:190 TALISMAN DR
Practice Address - Street 2:UNIT D4
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-731-1888
Practice Address - Fax:970-731-1889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPE647283OtherBCBS
CO28329767Medicaid
COPE647283OtherBCBS