Provider Demographics
NPI:1760103410
Name:AINSWORTH, THOMAS MONROE JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MONROE
Last Name:AINSWORTH
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:THOM
Other - Middle Name:
Other - Last Name:AINSWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:4505 42ND AVE SW UNIT 701
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4743
Mailing Address - Country:US
Mailing Address - Phone:360-900-8581
Mailing Address - Fax:
Practice Address - Street 1:4204 SW OREGON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4236
Practice Address - Country:US
Practice Address - Phone:206-938-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60936561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAINSWTM260RTOtherINSURANCE PROVIDERS