Provider Demographics
NPI:1427295021
Name:PUSATERI, LEANNE MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:MARIE
Last Name:PUSATERI
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 1:1818 MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390
Mailing Address - Country:US
Mailing Address - Phone:206-293-4007
Mailing Address - Fax:
Practice Address - Street 1:1818 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390
Practice Address - Country:US
Practice Address - Phone:206-293-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60066964171100000X
WAMA00023539225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist