MEDICARE: JENNIFER CERULLI 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	225700000X	Massage Therapist	00019782	WA

General Provider Information

NPI Number	:	1437670189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CERULLI LMP

Provider Business Mailing Address
First Line	:	6110 8TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-2813
Country	:	US
Telephone Number	:	206-818-9108
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 NE 41ST ST STE 208
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-5428
Country	:	US
Telephone Number	:	206-818-9108
Fax Number	:

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	07/03/2017

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Directions to “ JENNIFER CERULLI LMP” Practice Location

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