Provider Demographics
NPI:1245473412
Name:PILCH, PATTI JEAN (LMP)
Entity type:Individual
Prefix:MISS
First Name:PATTI
Middle Name:JEAN
Last Name:PILCH
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 1:2507 MILE HILL DRIVE
Mailing Address - Street 2:SUITE C8
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366
Mailing Address - Country:US
Mailing Address - Phone:360-895-2664
Mailing Address - Fax:360-895-2664
Practice Address - Street 1:2507 MILE HILL DRIVE
Practice Address - Street 2:SUITE C8
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-895-2664
Practice Address - Fax:360-895-2664
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA#00011635225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00011635OtherLMP#
WA118508OtherLABOR & INDUSTRY #
WA752986678-01OtherKPS #