Provider Demographics
NPI:1619058245
Name:FLOYD, THALASSA M (LMP)
Entity Type:Individual
Prefix:MS
First Name:THALASSA
Middle Name:M
Last Name:FLOYD
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 1:12402 ADMIRALTY WAY
Mailing Address - Street 2:APT I206
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5543
Mailing Address - Country:US
Mailing Address - Phone:425-355-6703
Mailing Address - Fax:
Practice Address - Street 1:6501 196TH ST SW STE C
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5980
Practice Address - Country:US
Practice Address - Phone:425-775-2288
Practice Address - Fax:425-778-5476
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1624FLOtherREGENCE
WA8245FLOtherREGENCE
WA8562FLOtherREGENCE
WA5845FLOtherREGENCE
WA6190FLOtherREGENCE
WA2454FLOtherREGENCE
WA0241221OtherL&I
WA8949209OtherL&I CRIME