Provider Demographics
NPI:1346610045
Name:ROSENGRANT, MICHAEL (LMP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ROSENGRANT
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 1:10655 NE 4TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5022
Mailing Address - Country:US
Mailing Address - Phone:425-455-2225
Mailing Address - Fax:425-454-7767
Practice Address - Street 1:10655 NE 4TH STREET SUITE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-455-2225
Practice Address - Fax:425-454-7767
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60558795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60558795OtherMASSAGE LICENSE