Healthcare Provider Details

I. General information

NPI: 1124355581
Provider Name (Legal Business Name): STEPHEN PULLMAN LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7923 32ND AVE SW
SEATTLE WA
98126-3537
US

IV. Provider business mailing address

7923 32ND AVE SW
SEATTLE WA
98126-3537
US

V. Phone/Fax

Practice location:
  • Phone: 206-406-8837
  • Fax:
Mailing address:
  • Phone: 206-406-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60118854
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60118854
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: