Provider Demographics
NPI:1447005020
Name:GEORGE, ERIC PATRICK (LMT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:PATRICK
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 EVANSTON AVE N APT 15
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8553
Mailing Address - Country:US
Mailing Address - Phone:608-333-7865
Mailing Address - Fax:
Practice Address - Street 1:1100 N 35TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8906
Practice Address - Country:US
Practice Address - Phone:206-309-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61506815225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist