Provider Demographics
NPI:1225240930
Name:GALIS, ELIZABETH ANN (BA, LMP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:GALIS
Suffix:
Gender:F
Credentials:BA, LMP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HOLLINGBERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, LMP
Mailing Address - Street 1:1815 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4235
Mailing Address - Country:US
Mailing Address - Phone:509-413-2215
Mailing Address - Fax:
Practice Address - Street 1:1815 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4235
Practice Address - Country:US
Practice Address - Phone:509-413-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
61-1485121OtherTAX IDENTIFICATION NUMBER