Healthcare Provider Details

I. General information

NPI: 1093413916
Provider Name (Legal Business Name): AMMAR MUHAMMAD HUSSAIN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 MERIDIAN AVE E
EDGEWOOD WA
98371-2108
US

IV. Provider business mailing address

17631 79TH AVENUE CT E
PUYALLUP WA
98375-2516
US

V. Phone/Fax

Practice location:
  • Phone: 253-840-1100
  • Fax: 253-840-1199
Mailing address:
  • Phone: 253-286-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61251940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: