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General NPI Number Information
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NPI Number | 1639459746
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Entity Type | Individual
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Provider Name | BRIGITTA MICHIKO BOLANOS LMP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 13333 NE BEL RED RD STE 210
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City | BELLEVUE
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State | WA
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Zip | 98005-2332
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Country | US
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Telephone | 425-333-8111
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Fax | 425-533-2386
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Provider Business Mailing Address
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Address Line | 715 141ST LN SE
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City | BELLEVUE
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State | WA
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Zip | 98007-6700
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Country | US
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Telephone | 425-378-8330
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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 | MA60234853
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License Number State | WA
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