Healthcare Provider Details

I. General information

NPI: 1861982654
Provider Name (Legal Business Name): JUDY CUELLAR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 14TH AVE S APT 14
SEATTLE WA
98144-3496
US

IV. Provider business mailing address

1300 14TH AVE S APT 14
SEATTLE WA
98144-3496
US

V. Phone/Fax

Practice location:
  • Phone: 209-732-0509
  • Fax:
Mailing address:
  • Phone: 206-327-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60851759
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: