Provider Demographics
NPI:1699116285
Name:JAMES, LISA MARIE (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:JAMES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610-9716
Mailing Address - Country:US
Mailing Address - Phone:989-329-5507
Mailing Address - Fax:
Practice Address - Street 1:621 COURT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8767
Practice Address - Country:US
Practice Address - Phone:989-343-3000
Practice Address - Fax:989-343-3003
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN67140006Medicare UPIN