Provider Demographics
NPI:1285713446
Name:HUBERT, SHANNON ELIZABETH (LMP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:HUBERT
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 1:1551 NW 54TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3845
Mailing Address - Country:US
Mailing Address - Phone:206-782-9505
Mailing Address - Fax:206-706-0303
Practice Address - Street 1:1551 NW 54TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3845
Practice Address - Country:US
Practice Address - Phone:206-782-9505
Practice Address - Fax:206-706-0303
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0171749OtherLABOR INDUSTRIES PROVIDER