Provider Demographics
NPI:1851694558
Name:DEFURIA, LISA (LMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:DEFURIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 SODORNO LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2464
Mailing Address - Country:US
Mailing Address - Phone:702-499-2975
Mailing Address - Fax:
Practice Address - Street 1:2808 SODORNO LN
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-2464
Practice Address - Country:US
Practice Address - Phone:702-499-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.3588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist