Provider Demographics
NPI:1417383951
Name:ALBA, NICHOLAS WESTRA (LMP, NMT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:WESTRA
Last Name:ALBA
Suffix:
Gender:M
Credentials:LMP, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2841
Mailing Address - Country:US
Mailing Address - Phone:719-696-0482
Mailing Address - Fax:
Practice Address - Street 1:804 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2841
Practice Address - Country:US
Practice Address - Phone:719-696-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60340408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist