Provider Demographics
NPI:1588012686
Name:SWOFFORD, LISA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SWOFFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1139
Mailing Address - Country:US
Mailing Address - Phone:806-796-1774
Mailing Address - Fax:806-796-1714
Practice Address - Street 1:3501 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1139
Practice Address - Country:US
Practice Address - Phone:806-796-1774
Practice Address - Fax:806-796-1714
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1220102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist