Provider Demographics
NPI:1164697371
Name:BEAN, KEVIN SCOTT (LMP, LBWP,)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:BEAN
Suffix:
Gender:M
Credentials:LMP, LBWP,
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:SCOTT
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1020 112 TH ST SW
Mailing Address - Street 2:APT# A-302
Mailing Address - City:EVERETT
Mailing Address - State:WASHINGTON
Mailing Address - Zip Code:98204
Mailing Address - Country:UM
Mailing Address - Phone:425-350-4049
Mailing Address - Fax:
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-348-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA515898-06225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist