Provider Demographics
NPI:1487788527
Name:JORGENSEN, CARMI ROMONA (LMT MMP)
Entity type:Individual
Prefix:
First Name:CARMI
Middle Name:ROMONA
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 264TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-8729
Mailing Address - Country:US
Mailing Address - Phone:425-644-6461
Mailing Address - Fax:425-898-0289
Practice Address - Street 1:5611 119TH AVE SE
Practice Address - Street 2:SUITE #4
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3799
Practice Address - Country:US
Practice Address - Phone:425-644-6461
Practice Address - Fax:425-746-4965
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00004373OtherLMT MMP