Provider Demographics
NPI:1003216565
Name:BOTH, BRITTANY SUE
Entity Type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:SUE
Last Name:BOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BELLEVUE AVE E
Mailing Address - Street 2:APT 302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 BELLEVUE AVE E
Practice Address - Street 2:APT 302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4750
Practice Address - Country:US
Practice Address - Phone:253-820-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60471815225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist