Provider Demographics
NPI:1972797751
Name:NORSTAD, LILLE K (PT)
Entity type:Individual
Prefix:
First Name:LILLE
Middle Name:K
Last Name:NORSTAD
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NM
Mailing Address - Zip Code:87013-0070
Mailing Address - Country:US
Mailing Address - Phone:575-289-3211
Mailing Address - Fax:
Practice Address - Street 1:50 COUNTY RD 13
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NM
Practice Address - Zip Code:87013
Practice Address - Country:US
Practice Address - Phone:575-289-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist