Provider Demographics
NPI:1205551397
Name:MURPHY, JACEY MAE (MT)
Entity type:Individual
Prefix:
First Name:JACEY
Middle Name:MAE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:JACEY
Other - Middle Name:MAE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:1112 FINNEGAN WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 FRONT ST STE 101
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1921
Practice Address - Country:US
Practice Address - Phone:360-383-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61351889225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist