Provider Demographics
NPI:1114274305
Name:MCCORT, ROSALYNNE (LMP)
Entity Type:Individual
Prefix:MS
First Name:ROSALYNNE
Middle Name:
Last Name:MCCORT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:E. MARA
Other - Middle Name:
Other - Last Name:ELBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4835 CALIFORNIA AVE SW
Mailing Address - Street 2:#401
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4466
Mailing Address - Country:US
Mailing Address - Phone:206-307-8901
Mailing Address - Fax:
Practice Address - Street 1:4835 CALIFORNIA AVE SW
Practice Address - Street 2:#401
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4466
Practice Address - Country:US
Practice Address - Phone:206-307-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00006403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist