Provider Demographics
NPI:1417230459
Name:MARIACHER, LISA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MARIACHER
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 1:34 QUEENS DR
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3227
Mailing Address - Country:US
Mailing Address - Phone:716-544-4436
Mailing Address - Fax:
Practice Address - Street 1:4269 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1724
Practice Address - Country:US
Practice Address - Phone:716-627-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
NY016714225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist