Provider Demographics
NPI:1760556500
Name:BARBER, LISA MARIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:BARBER
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 1:7021 188TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2423
Mailing Address - Country:US
Mailing Address - Phone:253-414-5308
Mailing Address - Fax:
Practice Address - Street 1:16007 56TH AVENUE CT E
Practice Address - Street 2:UNIT #1
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9004
Practice Address - Country:US
Practice Address - Phone:253-414-5308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0181516OtherL & I #
WA1534BAOtherBLUECROSS #
WAMA00018715OtherLICENSE