Provider Demographics
NPI:1932379781
Name:POORMAN, RICHARD (LMP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:POORMAN
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 1:1306 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3236
Mailing Address - Country:US
Mailing Address - Phone:509-438-6911
Mailing Address - Fax:888-814-3542
Practice Address - Street 1:8390 W GAGE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8105
Practice Address - Country:US
Practice Address - Phone:509-374-2600
Practice Address - Fax:888-814-3542
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist