MEDICARE: JANET MARIE BRADSHAW 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	MA00008675	WA

General Provider Information

NPI Number	:	1427227529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MARIE BRADSHAW LMP

Provider Business Mailing Address
First Line	:	5900 100TH ST SW
Second Line	:	STE 14-16
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2749
Country	:	US
Telephone Number	:	253-581-8456
Fax Number	:	253-581-8464

Provider Business Practice Location Address
First Line	:	5900 100TH ST SW
Second Line	:	STE 14-16
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2749
Country	:	US
Telephone Number	:	253-581-8456
Fax Number	:	253-581-8464

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

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	11/20/2008

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