Provider Demographics
NPI:1578820130
Name:NYE PEREZ, CHANTE ROSE (LMP)
Entity Type:Individual
Prefix:
First Name:CHANTE
Middle Name:ROSE
Last Name:NYE PEREZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CHANTE
Other - Middle Name:ROSE
Other - Last Name:NYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2203 BLAINE CIR SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4503
Mailing Address - Country:US
Mailing Address - Phone:360-584-2742
Mailing Address - Fax:
Practice Address - Street 1:15220 SE 272ND ST STE G
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4241
Practice Address - Country:US
Practice Address - Phone:253-630-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60253863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist