Provider Demographics
NPI:1689217267
Name:TONG, CARMINE (LMT)
Entity Type:Individual
Prefix:
First Name:CARMINE
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WESTLAKE AVE N STE 106
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3036
Mailing Address - Country:US
Mailing Address - Phone:206-657-7184
Mailing Address - Fax:
Practice Address - Street 1:1500 WESTLAKE AVE N STE 106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3036
Practice Address - Country:US
Practice Address - Phone:206-657-7184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA60962157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist