Provider Demographics
NPI:1366757635
Name:THOMAS, DAMON DARNELL (LMP)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:DARNELL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 OLIVE WAY
Mailing Address - Street 2:#1703
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1892
Mailing Address - Country:US
Mailing Address - Phone:206-229-8613
Mailing Address - Fax:
Practice Address - Street 1:809 OLIVE WAY
Practice Address - Street 2:#1703
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1892
Practice Address - Country:US
Practice Address - Phone:206-229-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60180042225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist