MEDICARE: TRISHA CAMPBELL LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA60770592	WA

General Provider Information

NPI Number	:	1083124168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA CAMPBELL LMT

Provider Business Mailing Address
First Line	:	2730 WESTLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-1916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 WESTLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-1916
Country	:	US
Telephone Number	:	206-352-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/03/2017

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