Provider Demographics
NPI:1609394360
Name:TAPIA, SIMON B (LMP)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:B
Last Name:TAPIA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FRONT ST S APT G204
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-4244
Mailing Address - Country:US
Mailing Address - Phone:425-499-1926
Mailing Address - Fax:
Practice Address - Street 1:600 FRONT ST S APT G204
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-4244
Practice Address - Country:US
Practice Address - Phone:425-499-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60752470225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist