MEDICARE: LISA P KNUTSON MPT

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	1135028	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	173447	OTHER	VA	ANTHEM SERVICES
3	2130616	OTHER	VA	MAMSI

General Provider Information

NPI Number	:	1144293390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA P KNUTSON MPT

Provider Business Mailing Address
First Line	:	6012 W WILLIAM CANNON DR BLDG C
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1980
Country	:	US
Telephone Number	:	512-899-8508
Fax Number	:	512-899-9387

Provider Business Practice Location Address
First Line	:	6012 W WILLIAM CANNON DR BLDG C
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1980
Country	:	US
Telephone Number	:	512-899-8508
Fax Number	:	512-899-9387

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	04/25/2017

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