Provider Demographics
NPI:1255738217
Name:WOODS, LISA MARIE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:WOODS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 COUNTY ROAD 1374
Mailing Address - Street 2:
Mailing Address - City:VINEMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35179-8057
Mailing Address - Country:US
Mailing Address - Phone:256-347-9607
Mailing Address - Fax:
Practice Address - Street 1:420 DEAN DR
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2763
Practice Address - Country:US
Practice Address - Phone:205-631-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA6996225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant