Healthcare Provider Details

I. General information

NPI: 1922632967
Provider Name (Legal Business Name): CARLIE JEAN LUBBESMEYER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S PINE ST STE 201
TACOMA WA
98405-2795
US

IV. Provider business mailing address

601 S PINE ST STE 201
TACOMA WA
98405-2795
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-1000
  • Fax:
Mailing address:
  • Phone: 253-396-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61555670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: