Healthcare Provider Details

I. General information

NPI: 1043156805
Provider Name (Legal Business Name): LYNISSA LASHAER COARD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N KOLB RD STE B
TUCSON AZ
85710-1333
US

IV. Provider business mailing address

162 W AVIATION DR
TUCSON AZ
85714-2613
US

V. Phone/Fax

Practice location:
  • Phone: 520-867-1660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT26146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: