Provider Demographics
NPI:1477884492
Name:LUNDIN, BECKY LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:LUNDIN
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:PO BOX 5498
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5498
Mailing Address - Country:US
Mailing Address - Phone:360-413-5863
Mailing Address - Fax:
Practice Address - Street 1:4422 14TH WAY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2615
Practice Address - Country:US
Practice Address - Phone:360-413-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007288225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist