Provider Demographics
NPI:1063715720
Name:ZHANG, BO (LMP)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:ZHANG
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:PO BOX 12543
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-2543
Mailing Address - Country:US
Mailing Address - Phone:206-787-2101
Mailing Address - Fax:
Practice Address - Street 1:8825 34TH AVE NE
Practice Address - Street 2:L-210
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-8085
Practice Address - Country:US
Practice Address - Phone:206-787-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60194193173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist