Provider Demographics
NPI:1538322292
Name:RODIN, JOE MARC (LMP)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:MARC
Last Name:RODIN
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 1:10916 LINDEN AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8822
Mailing Address - Country:US
Mailing Address - Phone:206-774-0353
Mailing Address - Fax:
Practice Address - Street 1:2111 N NORTHGATE WAY
Practice Address - Street 2:#221
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9018
Practice Address - Country:US
Practice Address - Phone:206-363-8240
Practice Address - Fax:206-363-8301
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00008751172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist