Provider Demographics
NPI:1588006316
Name:STEVENSON, PIXIE (LMP)
Entity Type:Individual
Prefix:
First Name:PIXIE
Middle Name:
Last Name:STEVENSON
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 1:9004 W SHOREWOOD DR APT 520
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-6209
Mailing Address - Country:US
Mailing Address - Phone:425-985-4466
Mailing Address - Fax:
Practice Address - Street 1:14850 LAKE HILLS BLVD
Practice Address - Street 2:#4
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5800
Practice Address - Country:US
Practice Address - Phone:425-985-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60141235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist