Provider Demographics
NPI:1164996781
Name:FOSTER, LISA KAYE (LMT, MMP, HHP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAYE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMT, MMP, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40520 W SANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-6626
Mailing Address - Country:US
Mailing Address - Phone:619-507-7430
Mailing Address - Fax:
Practice Address - Street 1:40520 W SANDERS WAY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-6626
Practice Address - Country:US
Practice Address - Phone:619-507-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-18864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-18864OtherSTATE LICENSE NUMBER