Provider Demographics
NPI:1790960706
Name:PADILLA-BRYSON, JESSIE E (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:E
Last Name:PADILLA-BRYSON
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 1:102 S 7TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-3982
Mailing Address - Country:US
Mailing Address - Phone:360-421-5377
Mailing Address - Fax:
Practice Address - Street 1:102 S 7TH ST APT D
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-3982
Practice Address - Country:US
Practice Address - Phone:360-421-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist