Provider Demographics
NPI:1083833909
Name:ALGARD, CHANDRA MAE (LMP, RBT)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:MAE
Last Name:ALGARD
Suffix:
Gender:F
Credentials:LMP, RBT
Other - Prefix:
Other - First Name:SHAWNIE
Other - Middle Name:
Other - Last Name:ALGARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP, RBT
Mailing Address - Street 1:6620 139TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-9398
Mailing Address - Country:US
Mailing Address - Phone:425-876-7555
Mailing Address - Fax:
Practice Address - Street 1:1101 AVENUE D
Practice Address - Street 2:STE D103
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2083
Practice Address - Country:US
Practice Address - Phone:360-568-2686
Practice Address - Fax:360-862-8016
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist