Provider Demographics
NPI:1770868168
Name:WEBSTER, JEFFREY ASHTON (LMP, NTP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ASHTON
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:LMP, NTP
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 25497
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98165-2397
Mailing Address - Country:US
Mailing Address - Phone:206-306-9391
Mailing Address - Fax:888-924-0687
Practice Address - Street 1:2208 NW MARKET ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4030
Practice Address - Country:US
Practice Address - Phone:206-306-9391
Practice Address - Fax:888-924-0687
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist