Provider Demographics
NPI:1487994992
Name:TOLY, SEAN VINCENT (LMP)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:VINCENT
Last Name:TOLY
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 1:8326 NE 187TH WAY
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2825
Mailing Address - Country:US
Mailing Address - Phone:425-890-3075
Mailing Address - Fax:425-419-4700
Practice Address - Street 1:8326 NE 187TH WAY
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2825
Practice Address - Country:US
Practice Address - Phone:425-890-3075
Practice Address - Fax:425-419-4700
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60333869225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist