Provider Demographics
NPI:1770826083
Name:ATKINS, DEAN (LMT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:ATKINS
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 1:4405 7TH AVE SE STE 304
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1055
Mailing Address - Country:US
Mailing Address - Phone:360-507-6482
Mailing Address - Fax:360-338-0242
Practice Address - Street 1:4405 7TH AVE SE STE 304
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1055
Practice Address - Country:US
Practice Address - Phone:360-507-6482
Practice Address - Fax:360-338-0242
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60333992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist