Provider Demographics
NPI:1457710055
Name:VAN RY, ZACHARY LEE (LMP)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:LEE
Last Name:VAN RY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 NE 169TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6042
Mailing Address - Country:US
Mailing Address - Phone:425-876-1154
Mailing Address - Fax:
Practice Address - Street 1:10021 HOLMAN RD NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4920
Practice Address - Country:US
Practice Address - Phone:206-632-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60549257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist