Provider Demographics
NPI:1013254796
Name:BRIGHT, GERALDINE PEARL (LMP)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:PEARL
Last Name:BRIGHT
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 1:11335 NE 122ND WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6933
Mailing Address - Country:US
Mailing Address - Phone:425-442-0863
Mailing Address - Fax:
Practice Address - Street 1:11335 NE 122ND WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6933
Practice Address - Country:US
Practice Address - Phone:425-442-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60293100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist