Provider Demographics
NPI:1194030916
Name:VONBARGEN, BETH EMILY
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:EMILY
Last Name:VONBARGEN
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 1:7030 BEACH DR SW # B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2050
Mailing Address - Country:US
Mailing Address - Phone:425-652-3433
Mailing Address - Fax:
Practice Address - Street 1:7030 BEACH DR SW # B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-2050
Practice Address - Country:US
Practice Address - Phone:425-652-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60175885225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist