=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689286494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA MARIE ELSONBATY DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2020
-----------------------------------------------------
Last Update Date | 11/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3290 NE 65TH ST UNIT 101
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-388-2549
-----------------------------------------------------
Fax | 206-829-4352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8750 GREENWOOD AVE N S-1
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-388-2549
-----------------------------------------------------
Fax | 206-829-4352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 61081002
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT61081002
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------