Provider Demographics
NPI:1780810481
Name:STOCKTON, BRYNNA LEIGH (LMP)
Entity type:Individual
Prefix:MISS
First Name:BRYNNA
Middle Name:LEIGH
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 BROADWAY APT 616
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3921
Mailing Address - Country:US
Mailing Address - Phone:360-280-1215
Mailing Address - Fax:
Practice Address - Street 1:431 BROADWAY APT 616
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3921
Practice Address - Country:US
Practice Address - Phone:360-280-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60021985225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist