Healthcare Provider Details

I. General information

NPI: 1265549513
Provider Name (Legal Business Name): BARBARA SUSAN WHITE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15709 GREENWOOD AVE N
SHORELINE WA
98133-5913
US

IV. Provider business mailing address

15709 GREENWOOD AVE N
SHORELINE WA
98133-5913
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-1592
  • Fax: 206-363-2167
Mailing address:
  • Phone: 206-363-1592
  • Fax: 206-363-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA11316
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: