Provider Demographics
NPI:1003563206
Name:ENGLEBERT, SETH THOMAS (LMT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:THOMAS
Last Name:ENGLEBERT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 E PIONEER STE D
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3502
Mailing Address - Country:US
Mailing Address - Phone:253-392-4817
Mailing Address - Fax:
Practice Address - Street 1:615 E PIONEER STE 109
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3317
Practice Address - Country:US
Practice Address - Phone:253-845-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61130864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist