Provider Demographics
NPI:1144491358
Name:TARR, LISA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:TARR
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 E BRONCOS PKWY UNIT 100
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-7111
Mailing Address - Country:US
Mailing Address - Phone:720-432-2860
Mailing Address - Fax:720-789-2210
Practice Address - Street 1:15530 E BRONCOS PKWY UNIT 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-7111
Practice Address - Country:US
Practice Address - Phone:720-432-2860
Practice Address - Fax:720-789-2210
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78782251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75508516Medicaid