Healthcare Provider Details

I. General information

NPI: 1427392349
Provider Name (Legal Business Name): BRODERICK J HUTCHINS LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 OLIVE WAY
SEATTLE WA
98101-1713
US

IV. Provider business mailing address

511 OLIVE WAY
SEATTLE WA
98101-1713
US

V. Phone/Fax

Practice location:
  • Phone: 206-705-1795
  • Fax:
Mailing address:
  • Phone: 206-705-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60303821
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: