Provider Demographics
NPI:1891263604
Name:REYES, LISA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:REYES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:7561 MAIN ST STE 402
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3993
Mailing Address - Country:US
Mailing Address - Phone:402-699-9188
Mailing Address - Fax:
Practice Address - Street 1:7561 MAIN STREET #402
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:NE
Practice Address - Zip Code:68127
Practice Address - Country:US
Practice Address - Phone:402-699-9188
Practice Address - Fax:402-339-7955
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE87-5285079OtherTHERAPEUTIC MASSAGE THERAPY LLC