Provider Demographics
NPI:1326363516
Name:WATT, MINDEL (LMP)
Entity Type:Individual
Prefix:
First Name:MINDEL
Middle Name:
Last Name:WATT
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 1:3401 EVANSTON AVE N
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8677
Mailing Address - Country:US
Mailing Address - Phone:206-718-2864
Mailing Address - Fax:206-858-9828
Practice Address - Street 1:3401 EVANSTON AVE N
Practice Address - Street 2:SUITE 316
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8677
Practice Address - Country:US
Practice Address - Phone:206-718-2864
Practice Address - Fax:206-858-9828
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60127124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist