Provider Demographics
NPI:1457538068
Name:MOFFETT, CASEY L (LMP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:L
Last Name:MOFFETT
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 1:11600 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE 3J
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5083
Mailing Address - Country:US
Mailing Address - Phone:360-253-6674
Mailing Address - Fax:360-253-8670
Practice Address - Street 1:11600 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 3J
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5083
Practice Address - Country:US
Practice Address - Phone:360-253-6674
Practice Address - Fax:360-253-8670
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019971225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist