Healthcare Provider Details

I. General information

NPI: 1740263136
Provider Name (Legal Business Name): LISA MARIE BUCHART DPT, COMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA VASEK

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 164TH AVE NE # 203
REDMOND WA
98052-3606
US

IV. Provider business mailing address

8630 164TH AVE NE # 203
REDMOND WA
98052-3606
US

V. Phone/Fax

Practice location:
  • Phone: 425-658-4980
  • Fax: 425-658-4977
Mailing address:
  • Phone: 425-658-4980
  • Fax: 425-658-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29810
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009992
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: