Individual
MRS. LISA P MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
7612 27TH STREET WEST, UNIVERSITY PLACE, WA 98466-4108
(425) 308-3564
(253) 336-4341
Mailing address
7612 27TH STREET WEST, UNIVERSITY PLACE, WA 98466-4108
(425) 308-3564
(253) 336-4341
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0150732
DEPT. OF LABOR & INDUSTRY
WA
01
—
4268MO
REGENCE BLUE SHIELD
WA
01
—
5924727
AETNA
WA
01
—
650021420
RAILROAD MEDICARE
WA
05
—
8336240
—
WA
01
—
8929895
L&I CRIME VICTIMS
WA
01
—
911745305-98223-A012
TRICARE
WA
Enumeration date
05/30/2006
Last updated
10/27/2022
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