Provider Demographics
NPI:1962887547
Name:BRUCE, TERAH (LMP)
Entity type:Individual
Prefix:
First Name:TERAH
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W REPUBLICAN ST
Mailing Address - Street 2:APT. C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4049
Mailing Address - Country:US
Mailing Address - Phone:425-563-8408
Mailing Address - Fax:
Practice Address - Street 1:1818 WESTLAKE AVE N
Practice Address - Street 2:STE 4-2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2777
Practice Address - Country:US
Practice Address - Phone:425-563-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60581227225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist