MEDICARE: JORDAN ANDERSON PAIGE 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	60749804	WA

General Provider Information

NPI Number	:	1699293761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ANDERSON PAIGE LMT

Provider Business Mailing Address
First Line	:	5447 49TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 SW ADMIRAL WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-2520
Country	:	US
Telephone Number	:	206-914-5998
Fax Number	:

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

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	09/08/2017

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