Provider Demographics
NPI:1568866424
Name:LIGHTSEY, PRISCILLA (PT,DPT,MA,HPCS)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:
Last Name:LIGHTSEY
Suffix:
Gender:F
Credentials:PT,DPT,MA,HPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2422
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-2422
Mailing Address - Country:US
Mailing Address - Phone:512-930-7625
Mailing Address - Fax:
Practice Address - Street 1:2050 ROCKRIDE LANE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78627
Practice Address - Country:US
Practice Address - Phone:512-930-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist