Provider Demographics
NPI:1669616777
Name:HART, NINA BETH (LMP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:BETH
Last Name:HART
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 1:3320 WEST MCGRAW ST.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199
Mailing Address - Country:US
Mailing Address - Phone:206-283-9910
Mailing Address - Fax:206-283-9935
Practice Address - Street 1:3320 WEST MCGRAW ST.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199
Practice Address - Country:US
Practice Address - Phone:206-283-9910
Practice Address - Fax:206-283-9935
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60070696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist