Provider Demographics
NPI:1770972242
Name:RUPPANER, LISA MARI (LMT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARI
Last Name:RUPPANER
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 1:1916 ELISE WAY
Mailing Address - Street 2:APT A
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1967
Mailing Address - Country:US
Mailing Address - Phone:323-252-6703
Mailing Address - Fax:
Practice Address - Street 1:533 E MICHELTORENA ST
Practice Address - Street 2:STE 204
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2200
Practice Address - Country:US
Practice Address - Phone:805-560-6666
Practice Address - Fax:805-770-2020
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14883225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist