Healthcare Provider Details

I. General information

NPI: 1174862999
Provider Name (Legal Business Name): LISAMARIE EDEN RAMOS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 121ST WAY NE SUITE F
KIRKLAND WA
98034-3051
US

IV. Provider business mailing address

13127 121ST WAY NE SUITE F
KIRKLAND WA
98034-3051
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-8631
  • Fax: 425-814-4731
Mailing address:
  • Phone: 425-823-8631
  • Fax: 425-814-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60329985
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: