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General NPI Number Information
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NPI Number | 1700341740
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Entity Type | Individual
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Provider Name | LUKE STAMBAUGH LMT
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Gender | Male
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 1409 140TH PL NE STE 107
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City | BELLEVUE
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State | WA
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Zip | 98007-3963
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Country | US
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Telephone | 206-979-1987
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Fax |
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Provider Business Mailing Address
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Address Line | 18311 NE 25TH ST
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City | REDMOND
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State | WA
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Zip | 98052-5953
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Country | US
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Telephone | 206-979-1987
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Fax | 425-747-0857
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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 | 0005332
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License Number State | WA
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