Provider Demographics
NPI:1346559549
Name:ATKINSON, MADISON LEA (LMP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LEA
Last Name:ATKINSON
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 1:2601 JAHN AVE NW
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8900
Mailing Address - Country:US
Mailing Address - Phone:253-857-6500
Mailing Address - Fax:253-857-2225
Practice Address - Street 1:2601 JAHN AVE NW
Practice Address - Street 2:SUITE A-7
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8900
Practice Address - Country:US
Practice Address - Phone:253-857-6500
Practice Address - Fax:253-857-2225
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00022088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist