Provider Demographics
NPI:1356580989
Name:LONG, THOMAS CHRISTIAN (LMP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHRISTIAN
Last Name:LONG
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2316 YALE AVE E
Mailing Address - Street 2:202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3350
Mailing Address - Country:US
Mailing Address - Phone:206-375-9771
Mailing Address - Fax:
Practice Address - Street 1:1605 12TH AVE
Practice Address - Street 2:22
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2467
Practice Address - Country:US
Practice Address - Phone:206-375-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist