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General NPI Number Information
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NPI Number | 1649284480
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Entity Type | Individual
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Provider Name | MARY LISA PRINCE MSPT
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 15600 REDMOND WAY SUITE 300
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City | REDMOND
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State | WA
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Zip | 98052-3862
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Country | US
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Telephone | 425-883-9089
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Fax | 425-869-1355
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Provider Business Mailing Address
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Address Line | 11711 NE 12TH ST #3A
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City | BELLEVUE
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State | WA
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Zip | 98005-2461
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Country | US
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Telephone | 425-450-9474
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Fax | 425-452-0704
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00008397
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License Number State | WA
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