Provider Demographics
NPI:1598887879
Name:PASTORE, JENNIFER M I (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PASTORE
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 101ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2703
Mailing Address - Country:US
Mailing Address - Phone:206-422-8082
Mailing Address - Fax:
Practice Address - Street 1:119 N COMMERCIAL ST STE 1100C
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4496
Practice Address - Country:US
Practice Address - Phone:206-422-8082
Practice Address - Fax:425-968-1624
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023904225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00023904OtherMASSAGE THERAPY LICENSE