Provider Demographics
NPI:1194903575
Name:STENSRUD, LISA M (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:STENSRUD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:39 S MAYSVILLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1354
Practice Address - Country:US
Practice Address - Phone:859-520-3171
Practice Address - Fax:859-520-3289
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2023-05-19
Deactivation Date:2023-05-04
Deactivation Code:
Reactivation Date:2023-05-18
Provider Licenses
StateLicense IDTaxonomies
MN8021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01021860OtherMCR RAILROAD MEDICARE
MNENROLLEDMedicaid
MNP01021860OtherMCR RAILROAD MEDICARE
MN650001944Medicare PIN