Healthcare Provider Details

I. General information

NPI: 1881369528
Provider Name (Legal Business Name): CASSIDY ROSE BAKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIDY ROSE SANFILIPPO

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15436 BEL RED RD STE 100
REDMOND WA
98052-5536
US

IV. Provider business mailing address

916 NE 65TH ST
SEATTLE WA
98115-5542
US

V. Phone/Fax

Practice location:
  • Phone: 206-267-0863
  • Fax:
Mailing address:
  • Phone: 206-267-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61191442
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: