Provider Demographics
NPI:1740440197
Name:GULSRUD, DREW ERIC (LMP)
Entity type:Individual
Prefix:MR
First Name:DREW
Middle Name:ERIC
Last Name:GULSRUD
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 1:235 WESTLAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5217
Mailing Address - Country:US
Mailing Address - Phone:206-749-5253
Mailing Address - Fax:
Practice Address - Street 1:235 WESTLAKE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5217
Practice Address - Country:US
Practice Address - Phone:206-749-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021569225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist