Healthcare Provider Details

I. General information

NPI: 1588142699
Provider Name (Legal Business Name): JAMES DEAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11314 4TH AVE W STE 103
EVERETT WA
98204-6926
US

IV. Provider business mailing address

3116 164TH ST SW APT 1906
LYNNWOOD WA
98087-3253
US

V. Phone/Fax

Practice location:
  • Phone: 425-355-3739
  • Fax: 425-514-8353
Mailing address:
  • Phone: 425-750-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: