Provider Demographics
NPI:1104362920
Name:ULRICH, MOLLY (LMT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-3430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY
Practice Address - Street 2:UNIT 200
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-381-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60530954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist