Provider Demographics
NPI:1063662500
Name:BRYAN, HEATHER KAY (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KAY
Last Name:BRYAN
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 1:2031 208TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7912
Mailing Address - Country:US
Mailing Address - Phone:425-771-6233
Mailing Address - Fax:
Practice Address - Street 1:19009 33RD AVE W
Practice Address - Street 2:SUITE 205
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4717
Practice Address - Country:US
Practice Address - Phone:425-776-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60026533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist