Provider Demographics
NPI:1710018064
Name:DOMNITZ, LINDA KAY (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KAY
Last Name:DOMNITZ
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 1:129 168TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-4536
Mailing Address - Country:US
Mailing Address - Phone:425-641-4182
Mailing Address - Fax:425-641-4182
Practice Address - Street 1:13400 NE 20TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2099
Practice Address - Country:US
Practice Address - Phone:206-919-5753
Practice Address - Fax:425-641-4182
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist