Provider Demographics
NPI:1689286494
Name:ELSONBATY, LISA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ELSONBATY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 GREENWOOD AVE N
Mailing Address - Street 2:S-1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-388-2549
Mailing Address - Fax:206-829-4352
Practice Address - Street 1:3290 NE 65TH ST UNIT 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-388-2549
Practice Address - Fax:206-829-4352
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61081002225100000X
WAPT610810022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist