Basic Information
| Provider Information | |||||||||
| NPI: | 1700018280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTENS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10900 73RD AVE N | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553695458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7633151296 | ||||||||
| FaxNumber: | 7633151297 | ||||||||
| Practice Location | |||||||||
| Address1: | 2334 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551141858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516458083 | ||||||||
| FaxNumber: | 6516458078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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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 | 225100000X | 8380 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 8380 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.