Provider Demographics
NPI:1356688527
Name:OWENS, LISA R (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:OWENS
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 1:450 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2860
Mailing Address - Country:US
Mailing Address - Phone:801-810-8348
Mailing Address - Fax:
Practice Address - Street 1:450 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2860
Practice Address - Country:US
Practice Address - Phone:801-810-8348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77578294701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist