Provider Demographics
NPI:1811247372
Name:PAVLISCHAK, LINDSEY ANNE (LMP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANNE
Last Name:PAVLISCHAK
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 1:5310 S SAYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-9122
Mailing Address - Country:US
Mailing Address - Phone:509-993-2932
Mailing Address - Fax:
Practice Address - Street 1:5310 S SAYBROOK LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-9122
Practice Address - Country:US
Practice Address - Phone:509-993-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60302880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist