Healthcare Provider Details

I. General information

NPI: 1629708672
Provider Name (Legal Business Name): MICHELLE AMALIE ESCUE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE AMALIE BROOKS-ESCUE MICHELLE BROOKS, LMP

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8103 FALLS AVE SE
SNOQUALMIE WA
98065-5169
US

IV. Provider business mailing address

PO BOX 34
NORTH BEND WA
98045-0034
US

V. Phone/Fax

Practice location:
  • Phone: 425-208-5048
  • Fax: 425-292-0253
Mailing address:
  • Phone: 425-208-5048
  • Fax: 425-292-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61292809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: