Provider Demographics
NPI:1801429758
Name:HORMANN-RIVARD, DEVIN (CCST, LMT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:HORMANN-RIVARD
Suffix:
Gender:M
Credentials:CCST, LMT
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:
Other - Last Name:RIVARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCST, LMT
Mailing Address - Street 1:221 NW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4909
Mailing Address - Country:US
Mailing Address - Phone:808-315-1512
Mailing Address - Fax:
Practice Address - Street 1:221 NW 100TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4909
Practice Address - Country:US
Practice Address - Phone:808-315-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61001181225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist