Provider Demographics
NPI:1588630016
Name:HINES, LISA N (,PT,DPT)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:N
Last Name:HINES
Suffix:
Gender:
Credentials:,PT,DPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:NANETTE
Other - Last Name:UPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT,OCS
Mailing Address - Street 1:1492 TINY TOWN RD STE A1&A2
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7873
Mailing Address - Country:US
Mailing Address - Phone:931-933-0918
Mailing Address - Fax:
Practice Address - Street 1:1492 TINY TOWN RD STE A1
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7874
Practice Address - Country:US
Practice Address - Phone:615-758-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist