Provider Demographics
NPI:1639459746
Name:BOLANOS, BRIGITTA MICHIKO (LMP)
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTA
Middle Name:MICHIKO
Last Name:BOLANOS
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 1:715 141ST LN SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-6700
Mailing Address - Country:US
Mailing Address - Phone:425-378-8330
Mailing Address - Fax:
Practice Address - Street 1:13333 NE BEL RED RD STE 210
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2332
Practice Address - Country:US
Practice Address - Phone:425-333-8111
Practice Address - Fax:425-533-2386
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60234853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist