Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1277551 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 1277551 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1277551 | TX |
NPI | 1053865675 |
---|---|
Provider Name | Dr. Lisa Ann Henderson |
First Address | Bedford, TX 76021-5903 |
Second Address | Bedford, TX 76021-5903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2016 |
Last Update Date | 14/09/2021 |