Provider Demographics
NPI:1457772204
Name:EDMUNDS, STEPHEN (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:EDMUNDS
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 1:7726 CENTER BLVD SE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-8748
Mailing Address - Country:US
Mailing Address - Phone:425-396-0613
Mailing Address - Fax:425-396-0614
Practice Address - Street 1:7726 CENTER BLVD SE
Practice Address - Street 2:SUITE 125
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8748
Practice Address - Country:US
Practice Address - Phone:425-396-0613
Practice Address - Fax:425-396-0614
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist