MEDICARE: LISA BREDESEN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA 60203905	WA

General Provider Information

NPI Number	:	1053702811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BREDESEN LMT

Provider Business Mailing Address
First Line	:	PO BOX 28968
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99228-8968
Country	:	US
Telephone Number	:	206-579-0563
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 N ASTOR ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-8102
Country	:	US
Telephone Number	:	509-210-0550
Fax Number	:	509-960-9003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	04/08/2025

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Directions to “ LISA BREDESEN LMT” Practice Location

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