Provider Demographics
NPI:1972866820
Name:LOVELETT, EMILY RUTH (LMP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:LOVELETT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 DAYTON ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3601
Mailing Address - Country:US
Mailing Address - Phone:206-387-7627
Mailing Address - Fax:
Practice Address - Street 1:555 DAYTON ST
Practice Address - Street 2:SUITE G
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3601
Practice Address - Country:US
Practice Address - Phone:206-387-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2015-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60270859225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist