Healthcare Provider Details

I. General information

NPI: 1619205960
Provider Name (Legal Business Name): MICHELLE ANN HALL LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N 205TH ST
SHORELINE WA
98133-3214
US

IV. Provider business mailing address

1201 3RD AVE STE 450
SEATTLE WA
98101-3000
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-2220
  • Fax: 206-546-2228
Mailing address:
  • Phone: 206-447-2220
  • Fax: 206-447-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60109471
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: