Provider Demographics
NPI:1417375072
Name:PULK, BRITTNEY (LMP)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:PULK
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 1:100 DENNIS ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-704-3300
Mailing Address - Fax:360-704-7676
Practice Address - Street 1:100 DENNIS ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6523
Practice Address - Country:US
Practice Address - Phone:360-704-3300
Practice Address - Fax:360-704-7676
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60447830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist