Provider Demographics
NPI:1114240389
Name:BUMGARNER, JANICE (LMT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BUMGARNER
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 1:2003 WESTERN AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2106
Mailing Address - Country:US
Mailing Address - Phone:206-478-6782
Mailing Address - Fax:206-448-4899
Practice Address - Street 1:2003 WESTERN AVE STE 510
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2106
Practice Address - Country:US
Practice Address - Phone:206-478-6782
Practice Address - Fax:206-448-4899
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024412225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist