Provider Demographics
NPI:1366696031
Name:IMOTO, JULIA K (LMP)
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:K
Last Name:IMOTO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28823 NE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-9650
Mailing Address - Country:US
Mailing Address - Phone:425-417-0380
Mailing Address - Fax:425-614-0679
Practice Address - Street 1:4122 FACTORIA BLVD SE
Practice Address - Street 2:STE 203
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4200
Practice Address - Country:US
Practice Address - Phone:425-614-0680
Practice Address - Fax:425-614-0679
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist