Provider Demographics
NPI:1558569723
Name:BETTS, LISA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:BETTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8518 ETON AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-2734
Mailing Address - Country:US
Mailing Address - Phone:818-700-9303
Mailing Address - Fax:818-700-9303
Practice Address - Street 1:8518 ETON AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-2734
Practice Address - Country:US
Practice Address - Phone:818-700-9303
Practice Address - Fax:818-700-9303
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist