Healthcare Provider Details

I. General information

NPI: 1336259449
Provider Name (Legal Business Name): REBECCA A MULLIGAN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 12TH AVE EAST
SEATTLE WA
98102
US

IV. Provider business mailing address

9340 35TH AVE NE
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-288-9911
  • Fax: 206-720-4004
Mailing address:
  • Phone: 206-200-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018054
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: