Provider Demographics
NPI:1568887321
Name:WOODY, LISA (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WOODY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 CAMPBELL RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1704
Mailing Address - Country:US
Mailing Address - Phone:469-688-0652
Mailing Address - Fax:
Practice Address - Street 1:7602 CAMPBELL RD
Practice Address - Street 2:SUITE 24
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1704
Practice Address - Country:US
Practice Address - Phone:469-688-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT047299225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist