MEDICARE: BRIDGET LALLY

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	70111317	WA

General Provider Information

NPI Number	:	1588599872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET LALLY

Provider Business Mailing Address
First Line	:	2113 26TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2265 N 56TH ST # 2B
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6209
Country	:	US
Telephone Number	:	206-590-4626
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ BRIDGET LALLY ” Practice Location

Language	Start Address	Practice Location

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