Provider Demographics
NPI:1134488307
Name:TUSSING, JENNIFER LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:TUSSING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 CALIFORNIA AVE SW
Mailing Address - Street 2:APT 5
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1685
Mailing Address - Country:US
Mailing Address - Phone:206-932-5520
Mailing Address - Fax:206-932-0296
Practice Address - Street 1:1621 CALIFORNIA AVE SW
Practice Address - Street 2:APT 5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-1685
Practice Address - Country:US
Practice Address - Phone:206-932-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60137339172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist