Provider Demographics
NPI:1992056642
Name:BACHA, MARIA (LMP, GCFP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BACHA
Suffix:
Gender:F
Credentials:LMP, GCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 S JACKSON ST
Mailing Address - Street 2:SUITE #30737
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2818
Mailing Address - Country:US
Mailing Address - Phone:646-504-7662
Mailing Address - Fax:877-216-9761
Practice Address - Street 1:93 S JACKSON ST
Practice Address - Street 2:SUITE #30737
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2818
Practice Address - Country:US
Practice Address - Phone:646-504-7662
Practice Address - Fax:877-216-9761
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60247745225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist