Healthcare Provider Details

I. General information

NPI: 1679886105
Provider Name (Legal Business Name): LISA ANN HUFFORD LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 196TH ST SW SUITE C
LYNNWOOD WA
98036-5980
US

IV. Provider business mailing address

6501 196TH ST SW SUITE C
LYNNWOOD WA
98036-5980
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-2288
  • Fax:
Mailing address:
  • Phone: 425-775-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60043871
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: