Provider Demographics
NPI:1558633966
Name:NORDQUIST, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:NORDQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 MUKILTEO SPEEDWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5442
Mailing Address - Country:US
Mailing Address - Phone:425-381-3866
Mailing Address - Fax:
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY STE 200
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-381-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60247229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist