Provider Demographics
NPI:1780753145
Name:WOLFE, ANDREW H (LMP)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:H
Last Name:WOLFE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:H
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:16410 SMOKEY POINT BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8415
Mailing Address - Country:US
Mailing Address - Phone:360-653-4657
Mailing Address - Fax:360-653-0143
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-653-4657
Practice Address - Fax:360-653-0143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist