Provider Demographics
NPI:1568400042
Name:MYRICK, JOAN (LMP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MYRICK
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 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:7728 204TH ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-2500
Practice Address - Country:US
Practice Address - Phone:360-403-8250
Practice Address - Fax:360-403-0917
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7679705OtherAETNA
WA8854MYOtherREGENCE BLUE SHIELD
WA8875MYOtherREGENCE BLUE SHIELD
WA0146797OtherDEPT. OF LABOR & INDUSTRY
WA8928862OtherL&I CRIME VICTIMS