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NPI Code Detail

MEDICARE: MS. LISA CAROLE HOOTEN PTA

MEDICARE: MS. LISA CAROLE HOOTEN PTA
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
1225200000XPhysical Therapy AssistantAT 447CA

General Provider Information

NPI Number : 1851789689
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA CAROLE HOOTEN PTA
Provider Business Mailing Address
First Line : 1322 MORNING GLORY PL
Second Line :
City : VISTA
State : CA
Zip : 92084-7222
Country : US
Telephone Number : 760-212-0664
Fax Number :
Provider Business Practice Location Address
First Line : 1260 E OHIO AVE
Second Line :
City : ESCONDIDO
State : CA
Zip : 92027-3054
Country : US
Telephone Number : 760-746-1100
Fax Number : 760-746-1201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/01/2015
Last Update Date : 01/01/2015

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