Provider Demographics
NPI:1912076308
Name:NEWMAN, JAMES DALE (LMP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DALE
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PACIFIC AVE
Mailing Address - Street 2:B-1
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4001
Mailing Address - Country:US
Mailing Address - Phone:425-258-5454
Mailing Address - Fax:425-258-1967
Practice Address - Street 1:1515 PACIFIC AVE
Practice Address - Street 2:B-1
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4001
Practice Address - Country:US
Practice Address - Phone:425-258-5454
Practice Address - Fax:425-258-1967
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA-00011996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist