Provider Demographics
NPI:1376657486
Name:COUTURIER, JACQUES JEAN-PAUL
Entity Type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:JEAN-PAUL
Last Name:COUTURIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14777 NE 40TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3300
Mailing Address - Country:US
Mailing Address - Phone:206-334-4840
Mailing Address - Fax:425-882-8583
Practice Address - Street 1:14777 NE 40TH ST STE 302
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3300
Practice Address - Country:US
Practice Address - Phone:206-334-4840
Practice Address - Fax:425-882-8583
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008831225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5598COOtherREGENCE BLUE SHIELD
WA0171194OtherLABOR & INDUSTRIES