Healthcare Provider Details

I. General information

NPI: 1932314325
Provider Name (Legal Business Name): CONSTANCE LYNN CARLSON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONNIE CARLSON LMP

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 36TH ST STE 319
SEATTLE WA
98103-8698
US

IV. Provider business mailing address

4121 DAYTON AVE N #101
SEATTLE WA
98103-7745
US

V. Phone/Fax

Practice location:
  • Phone: 206-518-1623
  • Fax:
Mailing address:
  • Phone: 206-518-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017684
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00017684
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: