Provider Demographics
NPI:1184193195
Name:SHIMIZU, REIKO
Entity Type:Individual
Prefix:
First Name:REIKO
Middle Name:
Last Name:SHIMIZU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 22ND AVE NW APT 518
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3473
Mailing Address - Country:US
Mailing Address - Phone:206-229-2255
Mailing Address - Fax:
Practice Address - Street 1:5621 22ND AVE NW APT 518
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3473
Practice Address - Country:US
Practice Address - Phone:206-229-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60879899225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist