Provider Demographics
NPI:1821324419
Name:MIZUSHIMA, NEAL H (LMP)
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:H
Last Name:MIZUSHIMA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17601 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1233
Mailing Address - Country:US
Mailing Address - Phone:425-457-6356
Mailing Address - Fax:
Practice Address - Street 1:17601 NE 141ST ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-1233
Practice Address - Country:US
Practice Address - Phone:425-457-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60086468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist