Provider Demographics
NPI:1316968951
Name:RUBRICH, LISA D (CO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:RUBRICH
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 LIEN RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3689
Mailing Address - Country:US
Mailing Address - Phone:608-242-9273
Mailing Address - Fax:608-242-9275
Practice Address - Street 1:4261 LIEN RD
Practice Address - Street 2:SUITE O
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3689
Practice Address - Country:US
Practice Address - Phone:608-242-9273
Practice Address - Fax:608-242-9275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICO 002289222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICO 002289OtherORTHOTIST