MEDICARE: LISA VASQUEZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1166143	TX

General Provider Information

NPI Number	:	1093735086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA VASQUEZ PT

Provider Business Mailing Address
First Line	:	6255 ESCONDIDO DR
Second Line	:	#10-D
City	:	EL PASO
State	:	TX
Zip	:	79912-1962
Country	:	US
Telephone Number	:	305-878-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 PERSHING DR
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79903-2403
Country	:	US
Telephone Number	:	915-562-8525
Fax Number	:	915-566-3889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	10/11/2007

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Directions to “ LISA VASQUEZ PT” Practice Location

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