Provider Demographics
NPI:1740762186
Name:POWELL, LISA (PT, ATP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 APPLEBLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033
Mailing Address - Country:US
Mailing Address - Phone:214-796-9893
Mailing Address - Fax:
Practice Address - Street 1:3280 APPLEBLOSSOM DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033
Practice Address - Country:US
Practice Address - Phone:214-796-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88979247200000X
TX1062198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other