Provider Demographics
NPI:1427044049
Name:RALSTON, LISA M (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:BUELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:3315 S 23RD ST
Practice Address - Street 2:SUITE 210
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1605
Practice Address - Country:US
Practice Address - Phone:253-572-8684
Practice Address - Fax:253-284-0450
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist