Provider Demographics
NPI:1760698773
Name:TIPTON, CINDY J (LMP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:J
Last Name:TIPTON
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:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324-0886
Mailing Address - Country:US
Mailing Address - Phone:360-808-0950
Mailing Address - Fax:
Practice Address - Street 1:863 CARLSBORG RD STE C
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-6962
Practice Address - Country:US
Practice Address - Phone:360-808-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00018416OtherLICENSE MASSAGE PRACTIONE