Individual
LISA BALLESTEROS REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1650 COCHRANE CIR UNIT MEDDAC, FORT CARSON, CO 80913-4604
(719) 526-7120
Mailing address
1650 COCHRANE CIR, FORT CARSON, CO 80913-4613
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0013412
CO
Other
Enumeration date
09/30/2015
Last updated
12/31/2024
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