Provider Demographics
NPI:1962422907
Name:CARRILLO, LISA (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1881 BERING DR APT 37
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3138
Mailing Address - Country:US
Mailing Address - Phone:713-278-1531
Mailing Address - Fax:713-278-1531
Practice Address - Street 1:1414 SOUTH LOOP W
Practice Address - Street 2:STE. #200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3825
Practice Address - Country:US
Practice Address - Phone:713-797-6106
Practice Address - Fax:713-490-1208
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist