Provider Demographics
NPI:1699507350
Name:BLUSIEWICZ, NICOLE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:BLUSIEWICZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 137TH LN SW
Mailing Address - Street 2:
Mailing Address - City:TENINO
Mailing Address - State:WA
Mailing Address - Zip Code:98589-8607
Mailing Address - Country:US
Mailing Address - Phone:425-443-9601
Mailing Address - Fax:
Practice Address - Street 1:1518 BISHOP RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7354
Practice Address - Country:US
Practice Address - Phone:360-923-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61578732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist