Provider Demographics
NPI:1700277498
Name:BRUCE, LINDELL MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LINDELL
Middle Name:MARIE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 SW 333RD PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2765
Mailing Address - Country:US
Mailing Address - Phone:253-344-1330
Mailing Address - Fax:
Practice Address - Street 1:27111 167TH PL SE
Practice Address - Street 2:SUITE 109
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-7337
Practice Address - Country:US
Practice Address - Phone:253-639-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60534591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist