Provider Demographics
NPI:1902176852
Name:BAROLDY, LEVI ROBERT (LMP)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:ROBERT
Last Name:BAROLDY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21616 SE 239TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8571
Mailing Address - Country:US
Mailing Address - Phone:206-455-1714
Mailing Address - Fax:
Practice Address - Street 1:21616 SE 239TH ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8571
Practice Address - Country:US
Practice Address - Phone:206-455-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60224963225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist