Provider Demographics
NPI:1518516038
Name:GOLIGHTLY, LISA JOANNE (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOANNE
Last Name:GOLIGHTLY
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 1:3987 SPRUCE CAPE RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6966
Mailing Address - Country:US
Mailing Address - Phone:808-343-1990
Mailing Address - Fax:
Practice Address - Street 1:2414 MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6654
Practice Address - Country:US
Practice Address - Phone:907-486-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK145611225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist