Provider Demographics
NPI:1619333796
Name:GARRETT, VICKY (LMT)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:GARRETT
Suffix:
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 1:14850 LAKE HILLS BLVD
Mailing Address - Street 2:SUITE B4
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14850 LAKE HILLS BLVD
Practice Address - Street 2:SUITE B4
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5800
Practice Address - Country:US
Practice Address - Phone:425-298-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60510449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist