Doctor Name: | MRS. LISA KAY ANN FELLSTROM |
NPI Number: | 1275838278 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MA60172813 |
Business Practice Address: | 16108 Ash Way Ste 109 Lynnwood, WA - 980878780 |
Business Phone Number: | 4257878000 |
Business Fax Number: | |
Mailing Address: | 5901 178th Pl Sw, LYNNWOOD |
State: | WA |
Postal Code: | 980373521 |
Phone Number: | 4257435217 |
Fax Number: | |
NPI Enumeration Date: | 01/21/2011 |
NPI Last Update Date: | 01/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA60172813 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |