Provider Demographics
NPI:1417257577
Name:MCCREARY, DOUG (LMP)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:MCCREARY
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 1:521 NW 196TH PL
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2543
Mailing Address - Country:US
Mailing Address - Phone:206-778-3684
Mailing Address - Fax:
Practice Address - Street 1:906 E JOHN ST
Practice Address - Street 2:#202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-6400
Practice Address - Country:US
Practice Address - Phone:206-778-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60115085225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist