Provider Demographics
NPI:1497028617
Name:LIND, PHOEBE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:MARIE
Last Name:LIND
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 1:4546 CALIFORNIA AVE SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4111
Mailing Address - Country:US
Mailing Address - Phone:206-450-2761
Mailing Address - Fax:
Practice Address - Street 1:4546 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE 202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4111
Practice Address - Country:US
Practice Address - Phone:206-450-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00020184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist