Provider Demographics
NPI:1386795284
Name:THOMPSON, LISA LYN (DPT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:LYN
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:611 W. HWY 6
Mailing Address - Street 2:STE 101
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710
Mailing Address - Country:US
Mailing Address - Phone:254-776-3070
Mailing Address - Fax:254-776-7909
Practice Address - Street 1:611 W. HWY 6
Practice Address - Street 2:STE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710
Practice Address - Country:US
Practice Address - Phone:254-776-3070
Practice Address - Fax:254-776-7909
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172878225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist