MEDICARE: BETHANIE SAND 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	MA00022511	WA

General Provider Information

NPI Number	:	1730398512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANIE SAND LMP

Provider Business Mailing Address
First Line	:	461 N 45TH ST APT 4
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6470
Country	:	US
Telephone Number	:	206-949-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N 36TH ST # 224
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8616
Country	:	US
Telephone Number	:	206-949-8442
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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Directions to “ BETHANIE SAND LMP” Practice Location

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