Provider Demographics
NPI:1306219761
Name:BIRD, ELIZABETH (LMP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BIRD
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 1:26488 OLD DAY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-7735
Mailing Address - Country:US
Mailing Address - Phone:360-391-5576
Mailing Address - Fax:
Practice Address - Street 1:325 E GEORGE HOPPER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3154
Practice Address - Country:US
Practice Address - Phone:360-707-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60144042225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist