Provider Demographics
NPI:1982937801
Name:CHIMIENTI, ELISA MADELINE (LMP)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MADELINE
Last Name:CHIMIENTI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 145TH AVE. S.E.
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290
Mailing Address - Country:US
Mailing Address - Phone:425-334-8926
Mailing Address - Fax:
Practice Address - Street 1:1610 145TH AVE. S.E.
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290
Practice Address - Country:US
Practice Address - Phone:425-334-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014615225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist