Provider Demographics
NPI:1053683052
Name:LIVING MEDICAL ARTS, PLLC
Entity Type:Organization
Organization Name:LIVING MEDICAL ARTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GULLA
Authorized Official - Suffix:
Authorized Official - Credentials:ND LMT CM
Authorized Official - Phone:425-949-7018
Mailing Address - Street 1:10516 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3714
Mailing Address - Country:US
Mailing Address - Phone:425-949-7018
Mailing Address - Fax:
Practice Address - Street 1:10516 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3714
Practice Address - Country:US
Practice Address - Phone:425-949-7018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60188651175F00000X
WAMA00023350225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty