Provider Demographics
NPI:1841615150
Name:VILLANUEVA, JASMIN FE (LMT)
Entity type:Individual
Prefix:
First Name:JASMIN FE
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NW GILMAN BLVD
Mailing Address - Street 2:PO BOX 2932
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0270
Mailing Address - Country:US
Mailing Address - Phone:425-281-2006
Mailing Address - Fax:
Practice Address - Street 1:72 E SUNSET WAY
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3813
Practice Address - Country:US
Practice Address - Phone:425-281-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60390895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist