Provider Demographics
NPI:1851419824
Name:METRICK, LISA ANNE (MS PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:METRICK
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3513
Mailing Address - Country:US
Mailing Address - Phone:303-581-9445
Mailing Address - Fax:
Practice Address - Street 1:WARDENBURG HEALTH CTR
Practice Address - Street 2:CAMPUS BOX 119
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0119
Practice Address - Country:US
Practice Address - Phone:303-492-6280
Practice Address - Fax:303-492-1248
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8019261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8019OtherPHYSICAL THERAPY LICENSE