Provider Demographics
NPI:1629308382
Name:PUGMIRE, SYDNEY LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LYNN
Last Name:PUGMIRE
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 1:340 15TH AVE E
Mailing Address - Street 2:STE 308
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5156
Mailing Address - Country:US
Mailing Address - Phone:206-931-4876
Mailing Address - Fax:
Practice Address - Street 1:340 15TH AVE E
Practice Address - Street 2:STE 308
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5808
Practice Address - Country:US
Practice Address - Phone:206-931-4876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60092440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist