Provider Demographics
NPI:1912386152
Name:VENEGAS, ROBERT WESLEIGH III (LMP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESLEIGH
Last Name:VENEGAS
Suffix:III
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 1:680 NW GILMAN BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2446
Mailing Address - Country:US
Mailing Address - Phone:425-427-6562
Mailing Address - Fax:
Practice Address - Street 1:680 NW GILMAN BLVD
Practice Address - Street 2:STE. A
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2446
Practice Address - Country:US
Practice Address - Phone:425-427-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60562022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist