Provider Demographics
NPI:1780882977
Name:MACDONALD, LISA ANN (LMT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12619 N LA MONTANA DR
Mailing Address - Street 2:#102
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4576
Mailing Address - Country:US
Mailing Address - Phone:480-837-8729
Mailing Address - Fax:480-837-2211
Practice Address - Street 1:11673 N SAGUARO BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4630
Practice Address - Country:US
Practice Address - Phone:480-837-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-01563P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist