Provider Demographics
NPI:1700654811
Name:LISINA, ERIKA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:LISINA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10938 NE 189TH ST UNIT H
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5009
Mailing Address - Country:US
Mailing Address - Phone:708-289-5705
Mailing Address - Fax:
Practice Address - Street 1:21827 76TH AVE W STE 101
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5141
Practice Address - Country:US
Practice Address - Phone:425-582-0930
Practice Address - Fax:425-582-7250
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61509632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist