Provider Demographics
NPI:1144511932
Name:ZEPEDA, LISA C (LMP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:ZEPEDA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:17528 MERIDIAN E
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375
Mailing Address - Country:US
Mailing Address - Phone:253-445-9030
Mailing Address - Fax:253-445-9031
Practice Address - Street 1:17528 MERIDIAN E
Practice Address - Street 2:SUITE 207
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375
Practice Address - Country:US
Practice Address - Phone:253-445-9030
Practice Address - Fax:253-445-9031
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60169592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist