Individual
LISA K GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2909 DANIELL CIR, BELLEVUE, NE 68123-1980
(123) 456-7890
Mailing address
2909 DANIELL CIR, BELLEVUE, NE 68123-1980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2621
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02460
BCBS NEBRASKA
NE
01
—
P00609476
RR MEDICARE
NE
Enumeration date
12/17/2007
Last updated
09/20/2010
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