Provider Demographics
NPI:1629560735
Name:DUBS, SEAN ROSSWELL (LMT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ROSSWELL
Last Name:DUBS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E DENNY WAY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6957
Mailing Address - Country:US
Mailing Address - Phone:267-206-0863
Mailing Address - Fax:
Practice Address - Street 1:417 E PINE ST STE P
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2378
Practice Address - Country:US
Practice Address - Phone:206-851-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60811295225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist