MEDICARE: ELISABETH CLAIRE FLEMING-PROT LMP

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	MA00019390	WA

General Provider Information

NPI Number	:	1265689038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH CLAIRE FLEMING-PROT LMP

Provider Business Mailing Address
First Line	:	6500 6TH AVE NW
Second Line	:	SUITE B
City	:	SEATTLE
State	:	WA
Zip	:	98117-5099
Country	:	US
Telephone Number	:	206-789-8567
Fax Number	:	206-508-2456

Provider Business Practice Location Address
First Line	:	7513 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4627
Country	:	US
Telephone Number	:	206-789-8567
Fax Number	:	206-789-8567

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/17/2011

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