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General NPI Number Information
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NPI Number | 1912059023
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Entity Type | Individual
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Provider Name | LORRI LEE ENWALL LMP
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17311 135TH AVE NE A 850
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City | WOODINVILLE
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State | WA
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Zip | 98072-3519
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Country | US
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Telephone | 425-415-1334
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Fax | 425-482-2896
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Provider Business Mailing Address
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Address Line | 19525 156TH AVE NE
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City | WOODINVILLE
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State | WA
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Zip | 98072-7001
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Country | US
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Telephone | 206-669-2611
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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 | MA00013180
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License Number State | WA
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