MEDICARE: JENNIFER LYNN TUSSING LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	MA60137339	WA

General Provider Information

NPI Number	:	1134488307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN TUSSING LMP

Provider Business Mailing Address
First Line	:	1621 CALIFORNIA AVE SW
Second Line	:	APT 5
City	:	SEATTLE
State	:	WA
Zip	:	98116-1685
Country	:	US
Telephone Number	:	206-932-5520
Fax Number	:	206-932-0296

Provider Business Practice Location Address
First Line	:	1621 CALIFORNIA AVE SW
Second Line	:	APT 5
City	:	SEATTLE
State	:	WA
Zip	:	98116-1685
Country	:	US
Telephone Number	:	206-932-5520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	05/09/2012

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