Provider Demographics
NPI:1164969580
Name:YANCHA, LYN FRIGILLANA (LMP)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:FRIGILLANA
Last Name:YANCHA
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 1:15 S GRADY WAY STE LL25
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3218
Mailing Address - Country:US
Mailing Address - Phone:425-228-5217
Mailing Address - Fax:425-271-4189
Practice Address - Street 1:15 S GRADY WAY STE LL25
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3218
Practice Address - Country:US
Practice Address - Phone:425-228-5217
Practice Address - Fax:425-271-4189
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA134029OtherWA STATE DEPT OF LABOR & INDUSTRIES
WAMA00012942OtherWASHINGTON DEPARTMENT OF HEALTH