Healthcare Provider Details

I. General information

NPI: 1437800703
Provider Name (Legal Business Name): DAVID ELLIOTT LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W BELL ST
SEQUIM WA
98382-3751
US

IV. Provider business mailing address

1112 E 5TH ST
PORT ANGELES WA
98362-4427
US

V. Phone/Fax

Practice location:
  • Phone: 360-670-3277
  • Fax:
Mailing address:
  • Phone: 360-670-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61262311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: