Provider Demographics
NPI:1194204966
Name:HARD, LISA (PTA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:HARD
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 1:4553 N LOOP 1604 W STE 1119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1364
Mailing Address - Country:US
Mailing Address - Phone:210-698-9844
Mailing Address - Fax:
Practice Address - Street 1:4553 N LOOP 1604 W STE 1119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1364
Practice Address - Country:US
Practice Address - Phone:210-698-9844
Practice Address - Fax:210-698-3220
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2059686225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant