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General NPI Number Information
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NPI Number | 1457190530
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Entity Type | Individual
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Provider Name | SOPHIA STEAD LMT, BCTMB
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 14713 SE 45TH PL
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City | BELLEVUE
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State | WA
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Zip | 98006-2432
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Country | US
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Telephone | 206-650-7674
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40264
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City | BELLEVUE
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State | WA
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Zip | 98015-4264
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Country | US
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Telephone | 206-650-7674
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00013593
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License Number State | WA
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