Provider Demographics
NPI:1952881013
Name:HOSTETLER, LISA RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-4924
Mailing Address - Country:US
Mailing Address - Phone:303-332-9111
Mailing Address - Fax:
Practice Address - Street 1:1560 E ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-4924
Practice Address - Country:US
Practice Address - Phone:303-332-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0017805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist