Provider Demographics
NPI:1104282094
Name:BARKER, LISA ANN (MPT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:BARKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28411 221ST AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MN
Mailing Address - Zip Code:56368-4528
Mailing Address - Country:US
Mailing Address - Phone:320-597-3623
Mailing Address - Fax:320-229-5183
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:STE. 1550
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-5199
Practice Address - Fax:320-229-5183
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist