Provider Demographics
NPI:1255689030
Name:HALES, LISA E (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:HALES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NW RICHMOND BEACH RD APT 279
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3103
Mailing Address - Country:US
Mailing Address - Phone:206-261-6022
Mailing Address - Fax:
Practice Address - Street 1:307 NW RICHMOND BEACH RD APT 279
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3103
Practice Address - Country:US
Practice Address - Phone:206-261-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60172767225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist