Provider Demographics
NPI:1184033524
Name:SWANSON, LISA JOY (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 S 133RD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5905
Mailing Address - Country:US
Mailing Address - Phone:402-330-8433
Mailing Address - Fax:402-330-8616
Practice Address - Street 1:13110 BIRCH DR
Practice Address - Street 2:STE 164
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-4160
Practice Address - Country:US
Practice Address - Phone:402-496-4666
Practice Address - Fax:402-496-1171
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist