Provider Demographics
NPI:1891874228
Name:HARVEY, RALSTON BRADFORD (LMP)
Entity type:Individual
Prefix:MR
First Name:RALSTON
Middle Name:BRADFORD
Last Name:HARVEY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 NE 88TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3736
Mailing Address - Country:US
Mailing Address - Phone:206-525-9031
Mailing Address - Fax:206-525-7388
Practice Address - Street 1:3849 NE 88TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-3736
Practice Address - Country:US
Practice Address - Phone:206-525-9031
Practice Address - Fax:206-525-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007661225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist