Provider Demographics
NPI:1124232004
Name:HUTCHINSON, KEITH ERIC (LMP)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ERIC
Last Name:HUTCHINSON
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 1:2803 230TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-8923
Mailing Address - Country:US
Mailing Address - Phone:425-749-1673
Mailing Address - Fax:
Practice Address - Street 1:8709 161ST AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3501
Practice Address - Country:US
Practice Address - Phone:425-883-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015883225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist