Provider Demographics
NPI:1710435078
Name:SPEZZA, ANTHONY MARTIN (LMT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARTIN
Last Name:SPEZZA
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 1:3121 E MADISON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4262
Mailing Address - Country:US
Mailing Address - Phone:206-734-4981
Mailing Address - Fax:888-734-4981
Practice Address - Street 1:3121 E MADISON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4262
Practice Address - Country:US
Practice Address - Phone:206-734-4981
Practice Address - Fax:888-734-4981
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60680076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist