Provider Demographics
NPI:1386979458
Name:TERAMOTO, GEORGE KAZUMASA (LMP, MAT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:KAZUMASA
Last Name:TERAMOTO
Suffix:
Gender:M
Credentials:LMP, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 INDUSTRY DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3404
Mailing Address - Country:US
Mailing Address - Phone:206-409-4007
Mailing Address - Fax:
Practice Address - Street 1:596 INDUSTRY DR
Practice Address - Street 2:SUITE 270
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3404
Practice Address - Country:US
Practice Address - Phone:206-409-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60112428225700000X
HIMAT4150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist