Basic Information
| Provider Information | |||||||||
| NPI: | 1144626722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARRICK | ||||||||
| FirstName: | JORDAN | ||||||||
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| Credential: | L.M.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2636 259TH CT SE | ||||||||
| Address2: | B2 | ||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980757923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256775060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 670 NW GILMAN BLVD | ||||||||
| Address2: | B2 | ||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980272444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254276562 | ||||||||
| FaxNumber: | 4253912760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA60424401 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.