Provider Demographics
NPI:1336346303
Name:WEBSTER, WENDY L (LMP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:WEBSTER
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 1:9414 STATE AVE
Mailing Address - Street 2:STE G
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2258
Mailing Address - Country:US
Mailing Address - Phone:360-653-6010
Mailing Address - Fax:360-653-6008
Practice Address - Street 1:9414 STATE AVE
Practice Address - Street 2:STE G
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2258
Practice Address - Country:US
Practice Address - Phone:360-653-6001
Practice Address - Fax:360-653-6008
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00021602OtherMASSAGE PRACTITIONER NUMB