Provider Demographics
NPI:1740623347
Name:BLASE, ARYN (LMP)
Entity type:Individual
Prefix:
First Name:ARYN
Middle Name:
Last Name:BLASE
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 1:7500 212TH ST SW
Mailing Address - Street 2:STE 101
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7641
Mailing Address - Country:US
Mailing Address - Phone:426-967-5037
Mailing Address - Fax:425-245-5894
Practice Address - Street 1:7500 212TH ST SW
Practice Address - Street 2:STE 101
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7641
Practice Address - Country:US
Practice Address - Phone:426-967-5037
Practice Address - Fax:425-245-5894
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60066744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist