Provider Demographics
NPI:1144895541
Name:ALBRECQ, WILLIAM GRAHAM (LMT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRAHAM
Last Name:ALBRECQ
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 1:230 PUGET LOOP
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-8794
Mailing Address - Country:US
Mailing Address - Phone:360-302-1825
Mailing Address - Fax:
Practice Address - Street 1:111 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-8792
Practice Address - Country:US
Practice Address - Phone:360-302-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60902265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist