Provider Demographics
NPI:1497395180
Name:WHITFIELD, DONALD (MA61003748)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:WHITFIELD
Suffix:
Gender:M
Credentials:MA61003748
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S TOBIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5338
Mailing Address - Country:US
Mailing Address - Phone:425-243-7705
Mailing Address - Fax:425-321-5508
Practice Address - Street 1:200 S TOBIN ST STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5338
Practice Address - Country:US
Practice Address - Phone:425-243-7705
Practice Address - Fax:425-321-5508
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61003748225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty