Provider Demographics
NPI:1093064859
Name:CARY-NEIHARDT, MEGHAN LOUISE (LMP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LOUISE
Last Name:CARY-NEIHARDT
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 1:1505 16TH LN NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7684
Mailing Address - Country:US
Mailing Address - Phone:425-270-3596
Mailing Address - Fax:
Practice Address - Street 1:6220 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:SUITE A
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8925
Practice Address - Country:US
Practice Address - Phone:425-557-8787
Practice Address - Fax:425-557-6757
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00010065225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist