Provider Demographics
NPI:1154775567
Name:WHISMAN, COURTNEY (LMP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WHISMAN
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 1:910 8TH AVE
Mailing Address - Street 2:APT 504
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 8TH AVE
Practice Address - Street 2:APT 504
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1225
Practice Address - Country:US
Practice Address - Phone:425-971-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60613057225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist