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General NPI Number Information
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NPI Number | 1487140513
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Entity Type | Individual
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Provider Name | JACOB CODY PIDDING LMT # MA60869105
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Gender | Male
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Dates
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Enumeration Date | 07/01/2018
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 606 120TH AVE NE STE 100 BUILDING D
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City | BELLEVUE
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State | WA
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Zip | 98005-3024
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Country | US
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Telephone | 425-688-0223
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Fax | 425-688-0323
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Provider Business Mailing Address
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Address Line | 3927 108TH AVE NE APT A202
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City | BELLEVUE
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State | WA
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Zip | 98004-7856
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Country | US
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Telephone | 509-452-5155
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Fax | 509-452-5355
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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 | MA60869105
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License Number State | WA
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