Provider Demographics
NPI:1437329000
Name:SCROGGS, DANIELLE TELAN (LMP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TELAN
Last Name:SCROGGS
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 1:14803 15TH AVE NE # 101
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7125
Mailing Address - Country:US
Mailing Address - Phone:206-861-3243
Mailing Address - Fax:206-299-3317
Practice Address - Street 1:14803 15TH AVE NE # 101
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7125
Practice Address - Country:US
Practice Address - Phone:206-861-3243
Practice Address - Fax:206-299-3317
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023828172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0226043OtherLABOR AND INDUSTRIES