Provider Demographics
NPI:1619584117
Name:BEARSS, AUDREE ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AUDREE
Middle Name:ELIZABETH
Last Name:BEARSS
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 1:4530B DOGWOOD ST SW
Mailing Address - Street 2:
Mailing Address - City:MCCHORD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:98439-1314
Mailing Address - Country:US
Mailing Address - Phone:323-739-8439
Mailing Address - Fax:
Practice Address - Street 1:4530B DOGWOOD ST SW
Practice Address - Street 2:
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98439-1314
Practice Address - Country:US
Practice Address - Phone:323-739-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61049813225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist