=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972822724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRINA INTHAXAI LMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2010
-----------------------------------------------------
Last Update Date | 05/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 116TH AVE NE SUITE C
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-3040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-228-0188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 162 159TH PL SE
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98008-4620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-228-0188
-----------------------------------------------------
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 | MA60134538
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------