Provider Demographics
NPI:1215269667
Name:WADSWORTH, STEPHEN (LMP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:WADSWORTH
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 1:2300 S MASSACHUSETTS ST
Mailing Address - Street 2:#106
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3821
Mailing Address - Country:US
Mailing Address - Phone:253-269-8779
Mailing Address - Fax:
Practice Address - Street 1:2300 S MASSACHUSETTS ST
Practice Address - Street 2:#106
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-3821
Practice Address - Country:US
Practice Address - Phone:253-269-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60060118225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist