Provider Demographics
NPI:1164685939
Name:HARRIS, LYDIA LUCIA (LMP, CYT)
Entity Type:Individual
Prefix:MISS
First Name:LYDIA
Middle Name:LUCIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMP, CYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MILROY ST NW
Mailing Address - Street 2:APT A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-0604
Mailing Address - Country:US
Mailing Address - Phone:360-359-3460
Mailing Address - Fax:
Practice Address - Street 1:1015 4TH AVE W
Practice Address - Street 2:SUITE G
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5467
Practice Address - Country:US
Practice Address - Phone:360-359-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024230225700000X
OR11923225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist