Provider Demographics
NPI:1427482793
Name:SWANSON, LISA BELL (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BELL
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELIZABETH
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2607 S SOUTHEAST BLVD STE B211
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7614
Mailing Address - Country:US
Mailing Address - Phone:509-443-4357
Mailing Address - Fax:509-242-3592
Practice Address - Street 1:2607 S SOUTHEAST BLVD STE B211
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7614
Practice Address - Country:US
Practice Address - Phone:509-443-4357
Practice Address - Fax:509-242-3592
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60366380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA142482793Medicaid
WAP01398083OtherRR MEDICARE PTAN
WA1427482793Medicaid
WA142482793Medicaid