Provider Demographics
NPI:1568727097
Name:ROSE, PAULA LYNNE (LMP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LYNNE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:LYNNE
Other - Last Name:COHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:11517 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6860
Mailing Address - Country:US
Mailing Address - Phone:206-547-2001
Mailing Address - Fax:
Practice Address - Street 1:11517 30TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6860
Practice Address - Country:US
Practice Address - Phone:206-547-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60130337225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist