Individual
BRIAN EDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
4525 164TH ST SW, # BB103, LYNNWOOD, WA 98087-8609
(360) 632-3710
Mailing address
PO BOX 14423, MILL CREEK, WA 98082-2423
(360) 632-3710
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60211133
WA
Other
Enumeration date
03/25/2011
Last updated
03/25/2011
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