Individual
LISA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
2200 BERGQUIST DR STE 1, ATTN: CREDENTIALS, LACKLAND A F B, TX 78236-9908
(210) 292-5034
Mailing address
2180 REESE ST BLDG 1285, BOX 128, LACKLAND A F B, TX 78236-1042
(505) 693-3593
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
1048445
TX
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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