Provider Demographics
NPI:1477715092
Name:YBARRA, ANDREW JOSEPH (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:YBARRA
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 1:2821 NW MARKET ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5815
Mailing Address - Country:US
Mailing Address - Phone:206-706-0063
Mailing Address - Fax:206-508-1265
Practice Address - Street 1:2821 NW MARKET ST
Practice Address - Street 2:SUITE E
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5815
Practice Address - Country:US
Practice Address - Phone:206-706-0063
Practice Address - Fax:206-508-1265
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60083915225700000X
WAOT 60530123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist