Provider Demographics
NPI:1164718417
Name:TRIPP, ROBERT J (LMP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:TRIPP
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 1:18021 15TH PL NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3806
Mailing Address - Country:US
Mailing Address - Phone:206-524-1330
Mailing Address - Fax:206-729-0433
Practice Address - Street 1:18021 15TH PL NE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-3806
Practice Address - Country:US
Practice Address - Phone:206-524-1330
Practice Address - Fax:206-729-0433
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60151194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist