Provider Demographics
NPI:1629266499
Name:VALENTINE, TODD D (LMP, SMT, NSCA-CPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:LMP, SMT, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4326
Mailing Address - Country:US
Mailing Address - Phone:253-271-9367
Mailing Address - Fax:866-439-4666
Practice Address - Street 1:4009 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE E-2
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4326
Practice Address - Country:US
Practice Address - Phone:253-271-9367
Practice Address - Fax:866-439-4666
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7127980606174400000X
WAMA00018495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist