Provider Demographics
NPI:1346491008
Name:OVERMAN, RODERICK D (LMP)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:D
Last Name:OVERMAN
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 1:10564 5TH AVE NE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-290-0770
Mailing Address - Fax:206-367-6177
Practice Address - Street 1:10564 5TH AVE NE
Practice Address - Street 2:SUITE 303
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-290-0770
Practice Address - Fax:206-367-6177
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist