Provider Demographics
NPI:1265549513
Name:WHITE, BARBARA SUSAN (LMP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:SUSAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15709 GREENWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5913
Mailing Address - Country:US
Mailing Address - Phone:206-363-1592
Mailing Address - Fax:206-363-2167
Practice Address - Street 1:15709 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5913
Practice Address - Country:US
Practice Address - Phone:206-363-1592
Practice Address - Fax:206-363-2167
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA11316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist