Provider Demographics
NPI:1073754495
Name:PRESTON, ANNUEL (LMP)
Entity Type:Individual
Prefix:
First Name:ANNUEL
Middle Name:
Last Name:PRESTON
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 1:3603 38TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-7123
Mailing Address - Country:US
Mailing Address - Phone:904-412-2517
Mailing Address - Fax:
Practice Address - Street 1:460 NE 70TH ST
Practice Address - Street 2:ELEMENTS THERAPEUTIC MASSAGE, GREEN LAKE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-522-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-14
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60276828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist