Provider Demographics
NPI:1114263811
Name:KINCAID, LASHAWN DENISE (PTA)
Entity Type:Individual
Prefix:MS
First Name:LASHAWN
Middle Name:DENISE
Last Name:KINCAID
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 E STASSNEY LN
Mailing Address - Street 2:1303
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4602
Mailing Address - Country:US
Mailing Address - Phone:512-944-6922
Mailing Address - Fax:
Practice Address - Street 1:5901 E STASSNEY LN
Practice Address - Street 2:1303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744
Practice Address - Country:US
Practice Address - Phone:512-944-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049221225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant