Basic Information
| Provider Information | |||||||||
| NPI: | 1558570440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAR | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 787 | ||||||||
| Address2: | |||||||||
| City: | FIRESTONE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805200787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7209381564 | ||||||||
| FaxNumber: | 7204943247 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 PROFESSIONAL LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805016972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037721600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.