Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2024842 | TX |
NPI | 1003341264 |
---|---|
Provider Name | Ms. Lisa Margaret Vlasek |
First Address | Ingram, TX 78025-3419 |
Second Address | San Antonio, TX 78251-4583 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2017 |
Last Update Date | 25/04/2017 |