Provider Demographics
NPI:1396901450
Name:DEROOY, EVELYN ELIZABETH (LMP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ELIZABETH
Last Name:DEROOY
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 1:4444 WOODLAND PARK AVE N
Mailing Address - Street 2:STE. 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7429
Mailing Address - Country:US
Mailing Address - Phone:206-227-8640
Mailing Address - Fax:
Practice Address - Street 1:4444 WOODLAND PARK AVE N
Practice Address - Street 2:STE. 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7429
Practice Address - Country:US
Practice Address - Phone:206-227-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA000014897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist