Provider Demographics
NPI:1699041186
Name:BRUCE, LISA M (LMP, NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LMP, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 26TH PL SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-5118
Mailing Address - Country:US
Mailing Address - Phone:253-693-8148
Mailing Address - Fax:
Practice Address - Street 1:2010 26TH PL SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-5118
Practice Address - Country:US
Practice Address - Phone:253-693-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60180429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist