Provider Demographics
NPI:1689858318
Name:SWAIN, LISA L (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:SWAIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2516
Mailing Address - Country:US
Mailing Address - Phone:425-387-3145
Mailing Address - Fax:
Practice Address - Street 1:297 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2516
Practice Address - Country:US
Practice Address - Phone:425-387-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015043172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist