Provider Demographics
NPI:1821590266
Name:CUGINI, DONNA (LMP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CUGINI
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 1:210 5TH AVE S STE 207
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3625
Mailing Address - Country:US
Mailing Address - Phone:435-501-3307
Mailing Address - Fax:
Practice Address - Street 1:210 5TH AVE S STE 207
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3625
Practice Address - Country:US
Practice Address - Phone:425-501-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00006740OtherMASSAGE
WAMA00006740OtherLICENSED MASSAGE