Provider Demographics
NPI:1497956171
Name:MORSE, LISA DIANE (LMT, EXP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:MORSE
Suffix:
Gender:F
Credentials:LMT, EXP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 US ROUTE 1
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1327
Mailing Address - Country:US
Mailing Address - Phone:207-712-0821
Mailing Address - Fax:
Practice Address - Street 1:202 US ROUTE 1
Practice Address - Street 2:SUITE 100
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1327
Practice Address - Country:US
Practice Address - Phone:207-712-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3224225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist