Provider Demographics
NPI:1760155311
Name:MCHUGH, SEAN GREGORY
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:GREGORY
Last Name:MCHUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 SHATTUCK PL S UNIT AA101
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6349
Mailing Address - Country:US
Mailing Address - Phone:253-797-9705
Mailing Address - Fax:
Practice Address - Street 1:4915 SHATTUCK PL S UNIT AA101
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6349
Practice Address - Country:US
Practice Address - Phone:253-797-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist