Provider Demographics
NPI:1962773911
Name:CARTER, LISA BROOKE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BROOKE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 WESTMORE WAY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3910
Mailing Address - Country:US
Mailing Address - Phone:301-873-2681
Mailing Address - Fax:
Practice Address - Street 1:1625 RADIO DR
Practice Address - Street 2:STE 220
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9407
Practice Address - Country:US
Practice Address - Phone:651-241-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist