Provider Demographics
NPI:1578752531
Name:HORAN, LISA DEBORD (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DEBORD
Last Name:HORAN
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 1:205 EAST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-1646
Mailing Address - Country:US
Mailing Address - Phone:979-743-4109
Mailing Address - Fax:979-743-2185
Practice Address - Street 1:205 EAST AVE STE B
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1646
Practice Address - Country:US
Practice Address - Phone:979-743-4109
Practice Address - Fax:979-743-2185
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist