Provider Demographics
NPI:1932335999
Name:ALSTON, LYNNE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:ALSTON
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 1:2402 12TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-3832
Mailing Address - Country:US
Mailing Address - Phone:253-640-3155
Mailing Address - Fax:
Practice Address - Street 1:2402 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-3832
Practice Address - Country:US
Practice Address - Phone:253-640-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA-00015660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist