Provider Demographics
NPI:1184778243
Name:BOOKER, ROYAL B (LMP)
Entity type:Individual
Prefix:MRS
First Name:ROYAL
Middle Name:B
Last Name:BOOKER
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 1:753 N 35TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8870
Mailing Address - Country:US
Mailing Address - Phone:206-632-3226
Mailing Address - Fax:206-267-3106
Practice Address - Street 1:753 N 35TH ST
Practice Address - Street 2:STE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8870
Practice Address - Country:US
Practice Address - Phone:206-632-3226
Practice Address - Fax:206-267-3106
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00001728225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist