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General NPI Number Information
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NPI Number | 1003708173
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Entity Type | Individual
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Provider Name | LISA MARIE WILLIAMS CMT, MLD-C, CLT
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Gender | Female
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 11/15/2025
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Provider Practice Location Address
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Address Line | 11090 183RD CIR NW STE A
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City | ELK RIVER
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State | MN
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Zip | 55330-2884
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Country | US
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Telephone | 763-691-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 217 DRESDEN ALCOVE
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City | WAVERLY
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State | MN
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Zip | 55390-5421
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Country | US
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Telephone | 763-691-3430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT21706206
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License Number State | IN
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