Provider Demographics
NPI:1205002979
Name:BOLDING, BRITTAINY (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:BRITTAINY
Middle Name:
Last Name:BOLDING
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 HARRIS AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:907-306-3936
Mailing Address - Fax:
Practice Address - Street 1:978 ABLE LN
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-8832
Practice Address - Country:US
Practice Address - Phone:907-306-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51892225700000X
TXMT105958225700000X
AK917540225700000X
WAMA 60163639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
543774-07OtherTHE NATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE & BODYWORK (NCBTMB)