Basic Information
| Provider Information | |||||||||
| NPI: | 1235308651 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGLEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2858 32ND AVE W | ||||||||
| Address2: | STE. 404 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981992600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066692716 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 NW MARKET ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981073987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067842800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2008 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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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 | MA00019609 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.