Provider Demographics
NPI:1487715017
Name:DAUM, LISETTE MOLINA (PT)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:MOLINA
Last Name:DAUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISETTE
Other - Middle Name:CACDAC
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:6601 BLUE OAKS BLVD APT 1508
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-6001
Mailing Address - Country:US
Mailing Address - Phone:510-565-9184
Mailing Address - Fax:
Practice Address - Street 1:6601 BLUE OAKS BLVD APT 1508
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-6001
Practice Address - Country:US
Practice Address - Phone:510-565-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist