Lisa Widdowson, LMT, CTT
Massage Therapist in La Vista, NE. Individual provider (NPI-1).
NPI number1114490604
StatusActive
Last updated in NPPESJan 7, 2019
Details
- NPI
- 1114490604
- Entity type
- Individual (NPI-1)
- Name
- Lisa Widdowson
- Credential
- LMT, CTT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 7, 2019
- Last updated
- Jan 7, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 2595 | NE | Yes |
| 173C00000X | Reflexologist | – | – | |
| 174H00000X | Health Educator | – | – | |
| 347C00000X | Private Vehicle | G01-370662 | NE |
Practice location
7200 S 84th St Ste 140La Vista, NE 68128-2115
Phone 402-915-1590 · Fax 402-939-0614
Mailing address
7210 S 75th StLa Vista, NE 68128-2220
Phone 402-590-9384 · Fax 402-939-0614
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