Individual
MRS. MISTY ANN LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1040 SW KIMBALL DR, OAK HARBOR, WA 98277-7593
(360) 675-8405
Mailing address
1139 WARNER ST, SEDRO WOOLLEY, WA 98284-1852
(360) 421-6925
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P1 60059910
WA
Other
Enumeration date
03/24/2009
Last updated
09/26/2011
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