=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740729003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN THOMAS ROBINSON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2017
-----------------------------------------------------
Last Update Date | 02/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4224 278TH AVE SE
-----------------------------------------------------
City | FALL CITY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98024-7007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-691-7978
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4224 278TH AVE SE
-----------------------------------------------------
City | FALL CITY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98024-7007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-691-7978
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60714382
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------