Provider Demographics
NPI:1033364666
Name:BURTRAW, LISA LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:BURTRAW
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 1:492 E 13TH AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4268
Mailing Address - Country:US
Mailing Address - Phone:541-349-0202
Mailing Address - Fax:541-719-4281
Practice Address - Street 1:492 E 13TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4268
Practice Address - Country:US
Practice Address - Phone:541-349-0202
Practice Address - Fax:541-719-4281
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5004261Q00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center