Provider Demographics
NPI:1316113103
Name:BIVENS, LISA JEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JEAN
Last Name:BIVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 MEMPHIS ARLINGTON RD
Mailing Address - Street 2:RAINBOW HEALTH & REHAB CENTER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133
Mailing Address - Country:US
Mailing Address - Phone:901-937-6302
Mailing Address - Fax:
Practice Address - Street 1:8119 MEMPHIS-ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:MPHS
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-937-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist