Provider Demographics
NPI:1861613549
Name:GRIFFEN, LISA KAY (LMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:GRIFFEN
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 1:4004 S TACOMA CT
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-3923
Mailing Address - Country:US
Mailing Address - Phone:509-438-3574
Mailing Address - Fax:
Practice Address - Street 1:4004 S TACOMA CT
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-3923
Practice Address - Country:US
Practice Address - Phone:509-438-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist