Healthcare Provider Details

I. General information

NPI: 1619890332
Provider Name (Legal Business Name): ISAAC GABRIEL WORDSWORTH LMT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18920 BOTHELL WAY NE STE 204
BOTHELL WA
98011-1981
US

IV. Provider business mailing address

15218 108TH PL NE
BOTHELL WA
98011-4840
US

V. Phone/Fax

Practice location:
  • Phone: 425-424-3730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA70148547
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: