Provider Demographics
NPI:1497094080
Name:HOLZ, LISA ANN (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:HOLZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:3220 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3305
Mailing Address - Country:US
Mailing Address - Phone:970-946-3029
Mailing Address - Fax:
Practice Address - Street 1:3225 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3304
Practice Address - Country:US
Practice Address - Phone:970-946-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60264392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist