Provider Demographics
NPI:1609475557
Name:ENCARNACION, NEYSSA LIZ (MSPT, LMT)
Entity Type:Individual
Prefix:
First Name:NEYSSA
Middle Name:LIZ
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:MSPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9705 GALLATIN LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-7331
Mailing Address - Country:US
Mailing Address - Phone:682-465-1722
Mailing Address - Fax:
Practice Address - Street 1:200 N RUFE SNOW DR STE 121
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4239
Practice Address - Country:US
Practice Address - Phone:682-465-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107129225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty