Provider Demographics
NPI:1730321415
Name:MOON, ROBIN L (LMP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:MOON
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 1:15220 SE 272ND ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4241
Mailing Address - Country:US
Mailing Address - Phone:253-630-6768
Mailing Address - Fax:253-630-6639
Practice Address - Street 1:15220 SE 272ND ST
Practice Address - Street 2:SUITE G
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4241
Practice Address - Country:US
Practice Address - Phone:253-630-6768
Practice Address - Fax:253-630-6639
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60040614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist