Provider Demographics
NPI:1538362421
Name:BARNES, LILLIAN B (LMP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:B
Last Name:BARNES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-0932
Mailing Address - Country:US
Mailing Address - Phone:509-521-0699
Mailing Address - Fax:
Practice Address - Street 1:7105 W HOOD PL
Practice Address - Street 2:BLDG A SUITE 103
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6714
Practice Address - Country:US
Practice Address - Phone:509-374-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist