Provider Demographics
NPI:1487830899
Name:BRYSON, CARMEN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:BRYSON
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 1:821 DOCK ST SLIP 4-10
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4607
Mailing Address - Country:US
Mailing Address - Phone:206-718-3263
Mailing Address - Fax:
Practice Address - Street 1:22000 MARINE VIEW DR S
Practice Address - Street 2:SUITE 202
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6233
Practice Address - Country:US
Practice Address - Phone:206-718-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist