Provider Demographics
NPI:1871609131
Name:AUSTIN, GLORIA (LMP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:AUSTIN
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 1:1830 BICKFORD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1749
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:360-568-7779
Practice Address - Street 1:2000 HEWITT AVE
Practice Address - Street 2:#115
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3600
Practice Address - Country:US
Practice Address - Phone:425-252-3908
Practice Address - Fax:425-252-7940
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist