Provider Demographics
NPI:1255675971
Name:RENSVOLD, CURTIS A (LMP)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:A
Last Name:RENSVOLD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 NE 4TH ST
Mailing Address - Street 2:SUITE #109
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4100
Mailing Address - Country:US
Mailing Address - Phone:425-277-0577
Mailing Address - Fax:425-277-0652
Practice Address - Street 1:3901 NE 4TH ST
Practice Address - Street 2:SUITE #109
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4100
Practice Address - Country:US
Practice Address - Phone:425-277-0577
Practice Address - Fax:425-277-0652
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60303920225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist