Provider Demographics
NPI:1306275292
Name:SWEARINGEN, ISAK (LMP)
Entity type:Individual
Prefix:
First Name:ISAK
Middle Name:
Last Name:SWEARINGEN
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 1:417 E PINE ST
Mailing Address - Street 2:SUITE P
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2395
Mailing Address - Country:US
Mailing Address - Phone:206-851-2242
Mailing Address - Fax:206-708-6472
Practice Address - Street 1:417 E PINE ST
Practice Address - Street 2:SUITE P
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2395
Practice Address - Country:US
Practice Address - Phone:206-851-2242
Practice Address - Fax:206-708-6472
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60414461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist