Provider Demographics
NPI:1932914306
Name:VIGLIOTTI, LISA JEAN (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:VIGLIOTTI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 OVERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3129
Mailing Address - Country:US
Mailing Address - Phone:857-258-0894
Mailing Address - Fax:
Practice Address - Street 1:173 OVERLAND TRL
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3129
Practice Address - Country:US
Practice Address - Phone:857-258-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2176925208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation