Provider Demographics
NPI:1316166325
Name:CRATER, LISA DIANNE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DIANNE
Last Name:CRATER
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 1:625 27TH ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-7760
Mailing Address - Country:US
Mailing Address - Phone:425-269-6575
Mailing Address - Fax:
Practice Address - Street 1:24030 132ND AVE SE
Practice Address - Street 2:STE A
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5109
Practice Address - Country:US
Practice Address - Phone:253-630-1332
Practice Address - Fax:253-639-4809
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist