Individual
MRS. LISA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1201 39TH ST, WASHOUGAL, WA 98671-9112
(360) 954-3180
Mailing address
1201 39TH ST, WASHOUGAL, WA 98671-9112
(360) 954-3180
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/21/2006
Last updated
09/05/2014
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