Stephen Edmunds, LMP

Individual provider Active NPI Massage Therapist · Snoqualmie, WA

NPI 1457772204 · NPPES record last updated Dec 20, 2013

Key facts

NPI
1457772204
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
MA00008520 (WA)
Practice address
7726 Center Blvd SE
Suite 125
Snoqualmie, WA 98065-8748
Phone
(425) 396-0613
Fax
(425) 396-0614
NPI assigned
Dec 20, 2013
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
MA00008520WAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jason Green, PLLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA00008520 WA Yes

Addresses

Primary practice location

7726 Center Blvd SE
Suite 125
Snoqualmie, WA 98065-8748

Mailing address

7726 Center Blvd SE
Suite 125
Snoqualmie, WA 98065-8748
Phone (425) 396-0613

Other providers in Snoqualmie, WA

All providers in Snoqualmie, WA · Massage Therapist in Washington

Sources for this page

Verify at the official NPI Registry.