Provider Demographics
NPI:1952865982
Name:MOBLEY, ERICA M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:M
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 35TH AVE SW UNIT 302
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2897
Mailing Address - Country:US
Mailing Address - Phone:907-359-5215
Mailing Address - Fax:
Practice Address - Street 1:4208 SW OREGON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4236
Practice Address - Country:US
Practice Address - Phone:206-938-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60925819225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60925819OtherMASSAGE LICENSE NUMBER