Healthcare Provider Details

I. General information

NPI: 1568678191
Provider Name (Legal Business Name): TED M SCHMID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25931 N.E. WASHINGTON BL.
KINGSTON WA
98346
US

IV. Provider business mailing address

PO BOX 1667
KINGSTON WA
98346-1667
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-5441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00005352
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: