Healthcare Provider Details

I. General information

NPI: 1548466600
Provider Name (Legal Business Name): H PATSY MCLOUGHLIN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N 181ST ST
SHORELINE WA
98133-4304
US

IV. Provider business mailing address

123 N 181ST ST
SHORELINE WA
98133-4304
US

V. Phone/Fax

Practice location:
  • Phone: 206-387-3398
  • Fax:
Mailing address:
  • Phone: 206-387-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00006871
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: