Provider Demographics
NPI:1629369970
Name:PENCE, JAMES WM (LMP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WM
Last Name:PENCE
Suffix:
Gender:M
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:PO BOX 1331
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-1331
Mailing Address - Country:US
Mailing Address - Phone:360-292-5479
Mailing Address - Fax:
Practice Address - Street 1:809 LEGION WAY SE
Practice Address - Street 2:SUITE 301
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1518
Practice Address - Country:US
Practice Address - Phone:360-292-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist