Healthcare Provider Details

I. General information

NPI: 1851521504
Provider Name (Legal Business Name): LEA RICHARDSON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 425-424-3730
  • Fax: 425-424-2371
Mailing address:
  • Phone: 425-424-3730
  • Fax: 425-424-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00010887
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: