Basic Information
| Provider Information | |||||||||
| NPI: | 1265588321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATKINSON | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4411 POINT FOSDICK DR NW STE 101 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538517472 | ||||||||
| FaxNumber: | 2538517473 | ||||||||
| Practice Location | |||||||||
| Address1: | 6712 KIMBALL DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538517277 | ||||||||
| FaxNumber: | 2538517297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | PT00007698 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 182401 | 01 | WA | LABOR & INDUSTRIES | OTHER | 8397275 | 05 | WA | MEDICAID |