Healthcare Provider Details

I. General information

NPI: 1477715092
Provider Name (Legal Business Name): ANDREW JOSEPH YBARRA LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 206-706-0063
  • Fax: 206-508-1265
Mailing address:
  • Phone: 206-706-0063
  • Fax: 206-508-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60083915
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 60530123
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: