Provider Demographics
NPI:1992912117
Name:ROBERTSON, LOIS A (LMT)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-9671
Mailing Address - Country:US
Mailing Address - Phone:509-447-3898
Mailing Address - Fax:509-447-3898
Practice Address - Street 1:322 SOUTH WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156
Practice Address - Country:US
Practice Address - Phone:509-447-3898
Practice Address - Fax:509-447-3898
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012486225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist