Provider Demographics
NPI:1043548076
Name:MATTERS, LISA H (LMP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:MATTERS
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 1:6830 COAL CREEK PKWY SE APT C202
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3025
Mailing Address - Country:US
Mailing Address - Phone:425-698-0911
Mailing Address - Fax:
Practice Address - Street 1:7808 PACIFIC AVE
Practice Address - Street 2:STE 7
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7039
Practice Address - Country:US
Practice Address - Phone:425-698-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60115964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist