Provider Demographics
NPI:1730357500
Name:WALLACE, JUDITH ANN (LMP)
Entity type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:ANN
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:318 2ND STREET SOUTH
Mailing Address - Street 2:TOUCH OF COMFORT MASSAGE
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-417-6795
Mailing Address - Fax:425-422-0495
Practice Address - Street 1:318 2ND STREET SOUTH
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:425-417-6795
Practice Address - Fax:425-422-0495
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020162225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist