Provider Demographics
NPI:1982964623
Name:BAUTISTA, JULIE A (LMP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BAUTISTA
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 1:8909 238TH ST SW APT 1
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8993
Mailing Address - Country:US
Mailing Address - Phone:425-967-2067
Mailing Address - Fax:
Practice Address - Street 1:19721 SCRIBER LAKE RD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6119
Practice Address - Country:US
Practice Address - Phone:425-775-3544
Practice Address - Fax:425-670-6502
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist