Provider Demographics
NPI:1144388778
Name:PAXTON, PATRICIA R (LMP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:PAXTON
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 1:21421 31ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7872
Mailing Address - Country:US
Mailing Address - Phone:425-424-3730
Mailing Address - Fax:425-424-2371
Practice Address - Street 1:18920 BOTHELL WAY NE
Practice Address - Street 2:SUITE 204
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1981
Practice Address - Country:US
Practice Address - Phone:425-424-3730
Practice Address - Fax:425-424-2371
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA10321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist