Provider Demographics
NPI:1407980501
Name:MODIANO, ENRICO (LMT)
Entity Type:Individual
Prefix:
First Name:ENRICO
Middle Name:
Last Name:MODIANO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 119TH AVE SE
Mailing Address - Street 2:SUITE 68
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3746
Mailing Address - Country:US
Mailing Address - Phone:425-643-7805
Mailing Address - Fax:
Practice Address - Street 1:5900 119TH AVE SE
Practice Address - Street 2:SUITE 68
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3746
Practice Address - Country:US
Practice Address - Phone:425-643-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA92236OtherLABOR & INDUSTRIES