Provider Demographics
NPI:1306960919
Name:GRUNSETH, LEIF (ATC, CNMT, LMT)
Entity type:Individual
Prefix:
First Name:LEIF
Middle Name:
Last Name:GRUNSETH
Suffix:
Gender:M
Credentials:ATC, CNMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BELLEVUE WAY NE # 214
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5721
Mailing Address - Country:US
Mailing Address - Phone:425-688-0356
Mailing Address - Fax:
Practice Address - Street 1:11521 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3026
Practice Address - Country:US
Practice Address - Phone:425-646-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0003261173000000X
WAMA00003261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered173000000XOther Service ProvidersLegal Medicine
Not Answered174400000XOther Service ProvidersSpecialist