Healthcare Provider Details

I. General information

NPI: 1053741306
Provider Name (Legal Business Name): REBECCA JEAN MOORMAN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2013
Last Update Date: 11/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 NW MARKET ST STE E
SEATTLE WA
98107-5815
US

IV. Provider business mailing address

1426 NW 61ST ST APT 4
SEATTLE WA
98107-2959
US

V. Phone/Fax

Practice location:
  • Phone: 206-706-0063
  • Fax: 206-580-1205
Mailing address:
  • Phone: 206-280-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60299284
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: