Provider Demographics
NPI:1225361363
Name:QUIGLEY, WAYNE BRADDON (LMP)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:BRADDON
Last Name:QUIGLEY
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 1:3611 I ST NE UNIT 27
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1816
Mailing Address - Country:US
Mailing Address - Phone:253-670-5101
Mailing Address - Fax:
Practice Address - Street 1:3611 I ST NE UNIT 27
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1816
Practice Address - Country:US
Practice Address - Phone:253-670-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60065421225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist