Provider Demographics
NPI:1174909337
Name:DESPAIN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DESPAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 FAWN CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1705
Mailing Address - Country:US
Mailing Address - Phone:512-680-4862
Mailing Address - Fax:
Practice Address - Street 1:2000 S IH 35
Practice Address - Street 2:SUITE L-1
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6900
Practice Address - Country:US
Practice Address - Phone:512-238-6200
Practice Address - Fax:512-238-6700
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist