Provider Demographics
NPI:1881876027
Name:AIKENS, LISA R (PT, ATC, MOMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:AIKENS
Suffix:
Gender:F
Credentials:PT, ATC, MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3162
Mailing Address - Country:US
Mailing Address - Phone:425-775-4778
Mailing Address - Fax:425-775-4778
Practice Address - Street 1:543 MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3162
Practice Address - Country:US
Practice Address - Phone:425-775-4778
Practice Address - Fax:425-775-4778
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8851693Medicare PIN