Provider Demographics
NPI:1114233632
Name:WINECOFF, MICHAEL S (LMP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:WINECOFF
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:MR
Other - First Name:SAME
Other - Middle Name:AS
Other - Last Name:ABOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:4921 FOBES RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-5125
Mailing Address - Country:US
Mailing Address - Phone:425-210-3222
Mailing Address - Fax:
Practice Address - Street 1:4921 FOBES RD
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-5125
Practice Address - Country:US
Practice Address - Phone:425-210-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist