Provider Demographics
NPI:1861118143
Name:BRUNNER, LISA MICHELLE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9036 COUNTY ROAD 628
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-6640
Mailing Address - Country:US
Mailing Address - Phone:979-665-8888
Mailing Address - Fax:
Practice Address - Street 1:9036 COUNTY ROAD 628
Practice Address - Street 2:
Practice Address - City:BRAZORIA
Practice Address - State:TX
Practice Address - Zip Code:77422-6640
Practice Address - Country:US
Practice Address - Phone:979-665-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10987542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic