Provider Demographics
NPI:1275189623
Name:SEBASTIAN, STEPHANIE MICHELE (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W CASINO RD APT 12F
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-1741
Mailing Address - Country:US
Mailing Address - Phone:602-321-3098
Mailing Address - Fax:
Practice Address - Street 1:16708 BOTHELL EVERETT HWY STE 202
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6345
Practice Address - Country:US
Practice Address - Phone:425-286-2712
Practice Address - Fax:425-286-2713
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60956387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist