Provider Demographics
NPI:1649443557
Name:FRENCH, LISA ANN (LMT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:FRENCH
Suffix:
Gender:F
Credentials:LMT
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 863
Mailing Address - Street 2:1403-12TH AVE
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-0863
Mailing Address - Country:US
Mailing Address - Phone:503-717-1181
Mailing Address - Fax:503-717-1181
Practice Address - Street 1:1403 12TH AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7138
Practice Address - Country:US
Practice Address - Phone:503-717-1181
Practice Address - Fax:503-717-1181
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12850225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500754-99OtherTAX ID #