Provider Demographics
NPI:1912723784
Name:BERNAZZANI, ISABELLA JADE (LMT)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:JADE
Last Name:BERNAZZANI
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 1:3722 121ST STREET CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8962
Mailing Address - Country:US
Mailing Address - Phone:970-560-0885
Mailing Address - Fax:
Practice Address - Street 1:5160 BORGEN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8809
Practice Address - Country:US
Practice Address - Phone:253-853-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61298970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist