Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1138071 | TX |
Y | 2251G0304X | Physical Therapist - Geriatrics | 1138071 | TX |
NPI | 1063574341 |
---|---|
Provider Name | Lisa Kathleen Winne |
First Address | Austin, TX 78749-4967 |
Second Address | Austin, TX 78735-1603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 25/02/2009 |