Mrs Lisa Ann Callery Koontz, RN, LMT is a
Massage Therapist based in Salem, Oregon. Mrs Lisa Ann Callery Koontz is licensed to practice in Oregon (license number 13994) and her current practice location is
3521 Mud Puppy Ln Se, Salem, Oregon. She can be reached at her office (for appointments etc.) via phone at
(503) 871-7717.
NPI number for Mrs Lisa Ann Callery Koontz is 1518667153 and her current mailing address is 3521 Mud Puppy Ln Se, Salem, Oregon. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1518667153.
Provider's Profile
Full Name | Mrs Lisa Ann Callery Koontz |
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Gender | Female |
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Speciality | Massage Therapist |
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Location | 3521 Mud Puppy Ln Se, Salem, Oregon |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1518667153
- Provider Enumeration Date: 03/02/2023
- Last Update Date: 03/02/2023
Medical Identifiers
Medical identifiers for Mrs Lisa Ann Callery Koontz such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1518667153 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
163W00000X | Registered Nurse | 096007075RN (Oregon) | Secondary |
225700000X | Massage Therapist | 13994 (Oregon) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Lisa Ann Callery Koontz is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mrs Lisa Ann Callery Koontz, RN, LMT 3521 Mud Puppy Ln Se, Salem, OR 97317-9434 Ph: (503) 871-7717 | Mrs Lisa Ann Callery Koontz, RN, LMT 3521 Mud Puppy Ln Se, Salem, OR 97317-9434 Ph: (503) 871-7717 |
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