Provider Demographics
NPI:1093845158
Name:MASAGATANI, JEFFREY ADEN (LMP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ADEN
Last Name:MASAGATANI
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 TERRY AVE UNIT 2603
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1993
Mailing Address - Country:US
Mailing Address - Phone:206-295-6897
Mailing Address - Fax:
Practice Address - Street 1:1600 DEXTER AVE N # C4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3079
Practice Address - Country:US
Practice Address - Phone:206-295-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist