Provider Demographics
NPI:1801016159
Name:CHARD, VIRGINIA LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LYNN
Last Name:CHARD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LYNN
Other - Last Name:BARNHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:8202 SR 104
Mailing Address - Street 2:SUITE 102 #37
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346
Mailing Address - Country:US
Mailing Address - Phone:360-271-7966
Mailing Address - Fax:
Practice Address - Street 1:8202 SR 104
Practice Address - Street 2:SUITE 102 #37
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346
Practice Address - Country:US
Practice Address - Phone:360-271-7966
Practice Address - Fax:360-876-6083
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00016525OtherSTATE LICENSE
WABL01447OtherPOULSBO BUSINESS LICENSE