Provider Demographics
NPI:1366403305
Name:PAGE, LISA R (DPT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:PAGE
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:11801 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2420
Mailing Address - Country:US
Mailing Address - Phone:505-271-9616
Mailing Address - Fax:505-345-8050
Practice Address - Street 1:11719 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1790
Practice Address - Country:US
Practice Address - Phone:505-345-8050
Practice Address - Fax:505-343-8050
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-12-02
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Provider Licenses
StateLicense IDTaxonomies
NM2636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist