Provider Demographics
NPI:1932321676
Name:NORMAN, PRICE DANIEL (LMP)
Entity Type:Individual
Prefix:MR
First Name:PRICE
Middle Name:DANIEL
Last Name:NORMAN
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 1:319 101ST AVE SE
Mailing Address - Street 2:#204
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8119
Mailing Address - Country:US
Mailing Address - Phone:425-818-8255
Mailing Address - Fax:
Practice Address - Street 1:1603 116TH AVE NE
Practice Address - Street 2:SUITE 116
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3009
Practice Address - Country:US
Practice Address - Phone:425-454-2313
Practice Address - Fax:425-454-2326
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00001406225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA030437156OtherFED TAX ID #
WANO5146OtherREGENCE BLUESHIELD
WA0094712OtherLABOR & INDUSTRIES DEPT
WAMA00001406OtherSTATE MASSAGE LICENSE