Provider Demographics
NPI:1790931129
Name:VA NORTH TEXAS HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:VA NORTH TEXAS HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:KINESIOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LYONELL
Authorized Official - Middle Name:LEVAUGHAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:KT
Authorized Official - Phone:214-857-0066
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-0066
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital