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NPI Code Detail

MEDICARE: LISA MARIE PAYNE LMT

MEDICARE: LISA MARIE PAYNE LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist023450OR

General Provider Information

NPI Number : 1861119661
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE PAYNE LMT
Provider Business Mailing Address
First Line : 5030 SE STEPHENS ST APT 405
Second Line :
City : PORTLAND
State : OR
Zip : 97215-3288
Country : US
Telephone Number : 541-520-8760
Fax Number :
Provider Business Practice Location Address
First Line : 2149 NE BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1580
Country : US
Telephone Number : 503-281-0278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2022
Last Update Date : 10/21/2022

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Directions to “ LISA MARIE PAYNE LMT” Practice Location

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