Basic Information
| Provider Information | |||||||||
| NPI: | 1255366910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSHI | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 PROVIDENCE LN NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985066927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604934645 | ||||||||
| FaxNumber: | 3604934470 | ||||||||
| Practice Location | |||||||||
| Address1: | 413 LILLY RD NE | ||||||||
| Address2: | MS: 01B03 | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604934159 | ||||||||
| FaxNumber: | 3604934470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00009269 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 176707 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 8931101 | 01 | WA | CRIME VICTIMS | OTHER | 2540KO | 01 | WA | REGENCE BLUE SHILED | OTHER | 9638875 | 05 | WA | MEDICAID |