Provider Demographics
NPI:1942464912
Name:DOLAN, ELAINE T (LMT, ROLFER, CST)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:T
Last Name:DOLAN
Suffix:
Gender:F
Credentials:LMT, ROLFER, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19028 104TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2924
Mailing Address - Country:US
Mailing Address - Phone:425-485-9181
Mailing Address - Fax:
Practice Address - Street 1:19028 104TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2924
Practice Address - Country:US
Practice Address - Phone:425-485-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010384225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist