Basic Information
| Provider Information | |||||||||
| NPI: | 1750471892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAAQOUBI | ||||||||
| FirstName: | SAID | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21600 HWY 99 | ||||||||
| Address2: | SIUTE150 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980268047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257742636 | ||||||||
| FaxNumber: | 4257742688 | ||||||||
| Practice Location | |||||||||
| Address1: | 21600 HWY 99 | ||||||||
| Address2: | SIUTE150 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980268047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257742636 | ||||||||
| FaxNumber: | 4257742688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA00018785 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 174400000X | MA00018785 | WA | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0208570 | 01 | WA | L/I | OTHER |