Provider Demographics
NPI:1063661957
Name:RICHTER, JOHN J (LMP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:RICHTER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-1018
Practice Address - Street 1:3710 168TH ST NE
Practice Address - Street 2:#A102
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8461
Practice Address - Country:US
Practice Address - Phone:360-658-8100
Practice Address - Fax:360-658-0508
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2015-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00006529225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist