Provider Demographics
NPI:1114907003
Name:HONG, LISA THU (PT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:THU
Last Name:HONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:THU
Other - Last Name:THAO HONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1615 75TH ST SW STE 210
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6293
Mailing Address - Country:US
Mailing Address - Phone:425-261-4780
Mailing Address - Fax:425-261-4720
Practice Address - Street 1:1615 75TH ST SW # S
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6293
Practice Address - Country:US
Practice Address - Phone:425-261-4780
Practice Address - Fax:425-261-4720
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8443814Medicaid
WAG8878936Medicare PIN