Provider Demographics
NPI:1669713152
Name:EARLY-ROSEN, LINDY (LMP)
Entity type:Individual
Prefix:MS
First Name:LINDY
Middle Name:
Last Name:EARLY-ROSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:EARLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 KING ST
Mailing Address - Street 2:STE. D
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6264
Mailing Address - Country:US
Mailing Address - Phone:360-671-4242
Mailing Address - Fax:360-671-4862
Practice Address - Street 1:1420 KING ST
Practice Address - Street 2:STE. D
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6264
Practice Address - Country:US
Practice Address - Phone:360-671-4242
Practice Address - Fax:360-671-4862
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA1838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91479OtherWA STATE LABOR AND INDUSTRIES
WA1838OtherMASSAGE THERAPIST LICENCE