Provider Demographics
NPI:1437443215
Name:PHIPPS, DANZEL LEE (LMP)
Entity Type:Individual
Prefix:
First Name:DANZEL
Middle Name:LEE
Last Name:PHIPPS
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 1:9433 4TH ST NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1653
Mailing Address - Country:US
Mailing Address - Phone:206-714-3512
Mailing Address - Fax:425-397-8681
Practice Address - Street 1:9433 4TH ST NE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1653
Practice Address - Country:US
Practice Address - Phone:206-714-3512
Practice Address - Fax:425-397-8681
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60179126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist