Provider Demographics
NPI:1053756478
Name:KRASOWSKI, LISA M (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KRASOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9575 ETHAN WADE WAY SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9575 ETHAN WADE WAY SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9577
Practice Address - Country:US
Practice Address - Phone:425-831-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160033900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP160033900OtherHEALTHCARE PROVIDER LICENSE