Provider Demographics
NPI:1801930276
Name:COBLENTZ, JULENE RENE (LMP)
Entity type:Individual
Prefix:
First Name:JULENE
Middle Name:RENE
Last Name:COBLENTZ
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 1:7701 DELRIDGE WAY SW APT 8E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3430
Mailing Address - Country:US
Mailing Address - Phone:206-383-6085
Mailing Address - Fax:
Practice Address - Street 1:3703 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3771
Practice Address - Country:US
Practice Address - Phone:206-937-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist