Provider Demographics
NPI:1235345117
Name:KIRK N LAMBERT
Entity Type:Organization
Organization Name:KIRK N LAMBERT
Other - Org Name:INTEGRATED MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-460-2818
Mailing Address - Street 1:968 VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1111
Mailing Address - Country:US
Mailing Address - Phone:253-380-0071
Mailing Address - Fax:253-460-7233
Practice Address - Street 1:2201 N 30TH ST STE C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3361
Practice Address - Country:US
Practice Address - Phone:253-627-5199
Practice Address - Fax:253-627-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601721636Medicare UPIN