Provider Demographics
NPI:1053505453
Name:VARGISON, JUDITH M (LMP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:M
Last Name:VARGISON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BRONSON WAY N STE G
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2163
Mailing Address - Country:US
Mailing Address - Phone:425-793-7700
Mailing Address - Fax:
Practice Address - Street 1:1102 BRONSON WAY N STE G
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2163
Practice Address - Country:US
Practice Address - Phone:425-793-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist