Provider Demographics
NPI:1306052535
Name:MIZE, ELIZABETH ANNA (BS, LMP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNA
Last Name:MIZE
Suffix:
Gender:F
Credentials:BS, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7153 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2008
Mailing Address - Country:US
Mailing Address - Phone:206-713-0775
Mailing Address - Fax:
Practice Address - Street 1:7153 FAUNTLEROY WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-2008
Practice Address - Country:US
Practice Address - Phone:206-713-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017624172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist