Provider Demographics
NPI:1205206984
Name:LEBRUN, E. HOUSTON (LMP)
Entity Type:Individual
Prefix:MS
First Name:E.
Middle Name:HOUSTON
Last Name:LEBRUN
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 1:1700 E MADISON ST
Mailing Address - Street 2:#404
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2798
Mailing Address - Country:US
Mailing Address - Phone:206-280-5645
Mailing Address - Fax:
Practice Address - Street 1:1700 E MADISON ST
Practice Address - Street 2:#404
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2798
Practice Address - Country:US
Practice Address - Phone:206-280-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00009286172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist