Provider Demographics
NPI:1093735086
Name:VASQUEZ, LISA (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CUMMINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6255 ESCONDIDO DR
Mailing Address - Street 2:#10-D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1962
Mailing Address - Country:US
Mailing Address - Phone:305-878-5220
Mailing Address - Fax:
Practice Address - Street 1:2900 PERSHING DR
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2403
Practice Address - Country:US
Practice Address - Phone:915-562-8525
Practice Address - Fax:915-566-3889
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist