Provider Demographics
NPI:1104378793
Name:SCHMIDT, JAMES R (LMP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:SCHMIDT
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 1:9 LAKE BELLEVUE DR
Mailing Address - Street 2:113
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2454
Mailing Address - Country:US
Mailing Address - Phone:425-635-0544
Mailing Address - Fax:425-450-0365
Practice Address - Street 1:9 LAKE BELLEVUE DR
Practice Address - Street 2:113
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2454
Practice Address - Country:US
Practice Address - Phone:425-635-0544
Practice Address - Fax:425-450-0365
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60473483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist