Provider Demographics
NPI:1376664904
Name:LEGOE, CYNTHIA ANN (LMP)
Entity Type:Individual
Prefix:PROF
First Name:CYNTHIA
Middle Name:ANN
Last Name:LEGOE
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 1:2602 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2215
Mailing Address - Country:US
Mailing Address - Phone:360-647-7999
Mailing Address - Fax:360-647-7986
Practice Address - Street 1:2602 HENRY ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2215
Practice Address - Country:US
Practice Address - Phone:360-647-7999
Practice Address - Fax:360-647-7986
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014371225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist