Provider Demographics
NPI:1154630218
Name:DRASZT, JACQUELYN (LMP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:DRASZT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:BIDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3211 56TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1359
Mailing Address - Country:US
Mailing Address - Phone:253-921-1092
Mailing Address - Fax:
Practice Address - Street 1:7808 PACIFIC AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7039
Practice Address - Country:US
Practice Address - Phone:253-921-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60179160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist