Provider Demographics
NPI:1407978919
Name:EATON, LISA (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-4570
Mailing Address - Country:US
Mailing Address - Phone:360-799-6921
Mailing Address - Fax:360-799-6922
Practice Address - Street 1:120 LAKESIDE AVE
Practice Address - Street 2:STE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6534
Practice Address - Country:US
Practice Address - Phone:206-405-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000087182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic