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General NPI Number Information
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NPI Number | 1639236433
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Entity Type | Individual
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Provider Name | LUATA LINDA FAYE BRAY L.M.P.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 13327 BEVERLY PARK RD
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City | LYNNWOOD
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State | WA
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Zip | 98087-1616
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Country | US
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Telephone | 425-743-7853
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Fax | 425-743-0233
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Provider Business Mailing Address
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Address Line | 13327 BEVERLY PARK RD
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City | LYNNWOOD
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State | WA
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Zip | 98087-1616
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Country | US
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Telephone | 425-743-7853
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Fax | 425-743-0233
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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 | MA00005841
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License Number State | WA
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