Provider Demographics
NPI:1326751181
Name:KAYSNER, M'LISSA (LMT)
Entity Type:Individual
Prefix:
First Name:M'LISSA
Middle Name:
Last Name:KAYSNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 LONGBOW RD
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3169
Mailing Address - Country:US
Mailing Address - Phone:425-314-0609
Mailing Address - Fax:425-320-4091
Practice Address - Street 1:9623 32ND ST SE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-5779
Practice Address - Country:US
Practice Address - Phone:425-314-0609
Practice Address - Fax:425-320-4910
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist