Provider Demographics
NPI:1710216106
Name:TINGSTAD, ELLIS ROBERT (LMP)
Entity Type:Individual
Prefix:
First Name:ELLIS
Middle Name:ROBERT
Last Name:TINGSTAD
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 1:8813 31ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3718
Mailing Address - Country:US
Mailing Address - Phone:206-355-1981
Mailing Address - Fax:
Practice Address - Street 1:8813 31ST AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3718
Practice Address - Country:US
Practice Address - Phone:206-355-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60113260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist