Provider Demographics
NPI:1801181177
Name:MEANS, WEDNESDAY ANNE (LMP)
Entity Type:Individual
Prefix:
First Name:WEDNESDAY
Middle Name:ANNE
Last Name:MEANS
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 1:744 MARKET ST UNIT 102A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3700
Mailing Address - Country:US
Mailing Address - Phone:253-272-9500
Mailing Address - Fax:253-272-9501
Practice Address - Street 1:744 MARKET ST UNIT 102A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3700
Practice Address - Country:US
Practice Address - Phone:253-272-9500
Practice Address - Fax:253-272-9501
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016410225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0268504OtherLABOR AND INDUSTRIES