Healthcare Provider Details

I. General information

NPI: 1306242581
Provider Name (Legal Business Name): JEFFREY MYRE LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10021 HOLMAN RD NW
SEATTLE WA
98177-4920
US

IV. Provider business mailing address

10021 HOLMAN RD NW
SEATTLE WA
98177-4920
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-8300
  • Fax: 206-632-8301
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60433869
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: