Provider Demographics
NPI:1508007766
Name:BUELL, LIAM C (LMP)
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:C
Last Name:BUELL
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 1:911 WESTERN AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1047
Mailing Address - Country:US
Mailing Address - Phone:206-111-1111
Mailing Address - Fax:
Practice Address - Street 1:911 WESTERN AVE STE 506
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1047
Practice Address - Country:US
Practice Address - Phone:206-111-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60073285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist