Provider Demographics
NPI:1336312206
Name:IANNI, DARRYL VINCENT (LMP)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:VINCENT
Last Name:IANNI
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 1:400 E PINE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2316
Mailing Address - Country:US
Mailing Address - Phone:206-623-5202
Mailing Address - Fax:206-623-0995
Practice Address - Street 1:400 E PINE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2316
Practice Address - Country:US
Practice Address - Phone:206-623-5202
Practice Address - Fax:206-623-0995
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024887225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist