Provider Demographics
NPI:1912532243
Name:ALVARADO, ROBERTO G (LMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:G
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:G
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 VUEMONT PL NE # 300
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4504
Mailing Address - Country:US
Mailing Address - Phone:425-243-7070
Mailing Address - Fax:
Practice Address - Street 1:418 N 35TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8607
Practice Address - Country:US
Practice Address - Phone:425-243-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60907261225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60907261OtherLMT#60907261