Provider Demographics
NPI:1396296083
Name:LISA MARIE PLLC
Entity type:Organization
Organization Name:LISA MARIE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-948-8232
Mailing Address - Street 1:5925 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1511
Mailing Address - Country:US
Mailing Address - Phone:509-948-8232
Mailing Address - Fax:
Practice Address - Street 1:5399 W VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-9305
Practice Address - Country:US
Practice Address - Phone:509-948-8232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60659313225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty