Healthcare Provider Details

I. General information

NPI: 1528272176
Provider Name (Legal Business Name): MS. BRENDA K. BECKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 103RD AVE NE
BELLEVUE WA
98004-5689
US

IV. Provider business mailing address

19729 207TH AVE SE
MONROE WA
98272-9370
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-1171
  • Fax: 425-451-1232
Mailing address:
  • Phone: 206-310-4052
  • Fax: 360-794-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: