Provider Demographics
NPI:1902028954
Name:HAMPTON, LISA D'ANN (LMP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:D'ANN
Last Name:HAMPTON
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 1:627 B STREET
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-1768
Mailing Address - Country:US
Mailing Address - Phone:509-235-2780
Mailing Address - Fax:
Practice Address - Street 1:627 B STREET
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-1768
Practice Address - Country:US
Practice Address - Phone:509-235-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA141107OtherLABOR AND INDUSTRIES