Provider Demographics
NPI:1598484339
Name:LEMASTER, JAYCUB ROBERT
Entity Type:Individual
Prefix:
First Name:JAYCUB
Middle Name:ROBERT
Last Name:LEMASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 AVENUE D STE D205
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2004
Mailing Address - Country:US
Mailing Address - Phone:360-217-8467
Mailing Address - Fax:360-217-7092
Practice Address - Street 1:1101 AVENUE D STE D205
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2004
Practice Address - Country:US
Practice Address - Phone:360-217-8467
Practice Address - Fax:360-217-7092
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61294478225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist