Provider Demographics
NPI:1487140182
Name:YOUNG, LISA PARIS (ATC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:PARIS
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:PARIS
Other - Last Name:WHITFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 T ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-3527
Mailing Address - Country:US
Mailing Address - Phone:360-393-0992
Mailing Address - Fax:
Practice Address - Street 1:415 T ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-3527
Practice Address - Country:US
Practice Address - Phone:360-393-0993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20000335172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer