Provider Demographics
NPI:1255366910
Name:KOSHI, LISA R (DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:KOSHI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PROVIDENCE LN NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6927
Mailing Address - Country:US
Mailing Address - Phone:360-493-4645
Mailing Address - Fax:360-493-4470
Practice Address - Street 1:413 LILLY RD NE
Practice Address - Street 2:MS: 01B03
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5133
Practice Address - Country:US
Practice Address - Phone:360-493-4159
Practice Address - Fax:360-493-4470
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA176707OtherDEPT OF LABOR & INDUSTRIE
WA8931101OtherCRIME VICTIMS
WA2540KOOtherREGENCE BLUE SHILED
WA9638875Medicaid
WA8931101OtherCRIME VICTIMS