Provider Demographics
NPI:1063899011
Name:BORROMEO, EDWARD MICHAEL (LMP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:MICHAEL
Last Name:BORROMEO
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 1:8500 NE HAZEL DELL AVE APT B4
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8071
Mailing Address - Country:US
Mailing Address - Phone:360-281-0837
Mailing Address - Fax:
Practice Address - Street 1:8500 NE HAZEL DELL AVE APT. B4
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-281-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist