Provider Demographics
NPI:1902692197
Name:SIMON, JAMES LEE (LMT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:SIMON
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 HARRINGTON AVE NE APT S409
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3479
Mailing Address - Country:US
Mailing Address - Phone:206-474-6696
Mailing Address - Fax:
Practice Address - Street 1:13353 NE BEL RED RD STE 103
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2329
Practice Address - Country:US
Practice Address - Phone:425-679-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61583726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist