Provider Demographics
NPI:1326252354
Name:PACOT, LISA D (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:PACOT
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 1:15259 DENSMORE AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6305
Mailing Address - Country:US
Mailing Address - Phone:206-941-0597
Mailing Address - Fax:
Practice Address - Street 1:15259 DENSMORE AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6305
Practice Address - Country:US
Practice Address - Phone:206-941-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00003247OtherWA STATE MASSAGE LICNESE