Provider Demographics
NPI:1356851018
Name:BRACKEN, JAMES HARTLEY (LMT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HARTLEY
Last Name:BRACKEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 GARRISON ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4333
Mailing Address - Country:US
Mailing Address - Phone:360-972-1028
Mailing Address - Fax:
Practice Address - Street 1:209 4TH AVE E STE 206
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-6969
Practice Address - Country:US
Practice Address - Phone:360-972-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60699061225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist