Provider Demographics
NPI:1073863916
Name:RODDA, ROSE LEONE (LMP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:LEONE
Last Name:RODDA
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 1:10635 NE 8TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4372
Mailing Address - Country:US
Mailing Address - Phone:425-455-1881
Mailing Address - Fax:
Practice Address - Street 1:10635 NE 8TH ST STE 104
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4372
Practice Address - Country:US
Practice Address - Phone:425-455-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist