Healthcare Provider Details

I. General information

NPI: 1154731875
Provider Name (Legal Business Name): ANDREA HALLOCK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15610 SE 272ND ST STE A106
COVINGTON WA
98042-4438
US

IV. Provider business mailing address

PO BOX 7089
COVINGTON WA
98042-0040
US

V. Phone/Fax

Practice location:
  • Phone: 253-638-2424
  • Fax: 253-639-5115
Mailing address:
  • Phone: 949-350-3310
  • Fax: 253-639-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number00013844
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: