Provider Demographics
NPI:1194932491
Name:SIBRIAN, AGNES KATALIN (LMP)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:KATALIN
Last Name:SIBRIAN
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 1:3510 S 132ND ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3979
Mailing Address - Country:US
Mailing Address - Phone:206-954-0958
Mailing Address - Fax:
Practice Address - Street 1:1603 116TH AVE NE SOUND
Practice Address - Street 2:NEUROMUSCULAR THERAPY STE 111
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-455-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009796225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist