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Individual

LISA A WEATHERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
1707 S COLORADO ST, SUITE A, GREENVILLE, MS 38703-7275
(662) 335-8332
(662) 335-8852
Mailing address
1707 S COLORADO ST, SUITE A, GREENVILLE, MS 38703-7275
(662) 335-8332
(662) 335-8852

Taxonomy

Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
PT4686
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09015486
MS
01
640925683
BCBS
MS
Enumeration date
06/10/2010
Last updated
06/10/2010
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