Provider Demographics
NPI:1902135106
Name:SPORS, LISA E (MS, ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:SPORS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 HPER CENTER
Mailing Address - Street 2:SOUTH DAKOTA STATE UNIVERSITY
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57007-1497
Mailing Address - Country:US
Mailing Address - Phone:605-688-5996
Mailing Address - Fax:605-688-5999
Practice Address - Street 1:2820 HPER CENTER
Practice Address - Street 2:SOUTH DAKOTA STATE UNIVERSITY
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57007-1497
Practice Address - Country:US
Practice Address - Phone:605-688-5996
Practice Address - Fax:605-688-5999
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer