Healthcare Provider Details

I. General information

NPI: 1518100320
Provider Name (Legal Business Name): ROBYN VAN DER LINDEN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19102 N CREEK PKWY 104
BOTHELL WA
98011-8005
US

IV. Provider business mailing address

PO BOX 1872
BOTHELL WA
98041-1872
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-6079
  • Fax:
Mailing address:
  • Phone: 425-486-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60058106
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMA 60058106
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWASHINGTON STATE DEPT OF HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: