Provider Demographics
NPI:1982936696
Name:RUNBECK, JESSICA LISBETH (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LISBETH
Last Name:RUNBECK
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 1:16801 E MISSION PKWY P305
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:206-334-5876
Mailing Address - Fax:
Practice Address - Street 1:6701 N COUNTRY HOMES BLVD # 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4336
Practice Address - Country:US
Practice Address - Phone:206-334-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60123475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0259583OtherL&I