Provider Demographics
NPI:1760808612
Name:CHANCE, LISA (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CHANCE
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 1:100 E FERGUSON ST
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-5759
Mailing Address - Country:US
Mailing Address - Phone:902-509-2040
Mailing Address - Fax:903-534-5873
Practice Address - Street 1:100 E FERGUSON ST
Practice Address - Street 2:SUITE 1204
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5759
Practice Address - Country:US
Practice Address - Phone:902-509-2040
Practice Address - Fax:903-534-5873
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11729632251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics