Provider Demographics
NPI:1063010791
Name:SIMMONDS, BRIDGET ANN (LMT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANN
Last Name:SIMMONDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 MELROSE AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2061
Mailing Address - Country:US
Mailing Address - Phone:206-914-0469
Mailing Address - Fax:
Practice Address - Street 1:2719 E MADISON ST STE 203
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4752
Practice Address - Country:US
Practice Address - Phone:206-568-7545
Practice Address - Fax:206-568-8298
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61108720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist