Provider Demographics
NPI:1689621914
Name:MOORE, LISA P (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:P
Last Name:MOORE
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 1:7612 27TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4108
Mailing Address - Country:US
Mailing Address - Phone:425-308-3564
Mailing Address - Fax:253-336-4341
Practice Address - Street 1:7612 27TH STREET WEST
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4108
Practice Address - Country:US
Practice Address - Phone:425-308-3564
Practice Address - Fax:253-336-4341
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0150732OtherDEPT. OF LABOR & INDUSTRY
WA911745305-98223-A012OtherTRICARE
WA4268MOOtherREGENCE BLUE SHIELD
WA8336240Medicaid
WA650021420OtherRAILROAD MEDICARE
WA5924727OtherAETNA
WA8929895OtherL&I CRIME VICTIMS