Provider Demographics
NPI:1174821995
Name:FOLINO, SHANNAN L (LMP)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:L
Last Name:FOLINO
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 1:607 S 188TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2037
Mailing Address - Country:US
Mailing Address - Phone:206-795-6041
Mailing Address - Fax:
Practice Address - Street 1:607 S 188TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-2037
Practice Address - Country:US
Practice Address - Phone:206-795-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00005052225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist