Healthcare Provider Details

I. General information

NPI: 1063574341
Provider Name (Legal Business Name): LISA KATHLEEN WINNE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BARTON CREEK BLVD
AUSTIN TX
78735-1603
US

IV. Provider business mailing address

8901 VERONA TRL
AUSTIN TX
78749-4967
US

V. Phone/Fax

Practice location:
  • Phone: 512-617-9805
  • Fax:
Mailing address:
  • Phone: 803-640-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1138071
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1138071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: