Provider Demographics
NPI:1891836904
Name:PERROTTA, PAUL (LMP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:PERROTTA
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 1:6300 9TH AVE NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8515
Mailing Address - Country:US
Mailing Address - Phone:206-729-8000
Mailing Address - Fax:206-524-1019
Practice Address - Street 1:6300 9TH AVE NE
Practice Address - Street 2:SUITE 310
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8515
Practice Address - Country:US
Practice Address - Phone:206-729-8000
Practice Address - Fax:206-524-1019
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0158715OtherLABOR AND INDUSTRIES
WA1342PEOtherREGENCE PIN