Provider Demographics
NPI:1679734750
Name:MULDOON, HIROMI T
Entity type:Individual
Prefix:
First Name:HIROMI
Middle Name:T
Last Name:MULDOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8418 26TH AVE SW
Mailing Address - Street 2:UNIT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3251
Mailing Address - Country:US
Mailing Address - Phone:206-245-8699
Mailing Address - Fax:
Practice Address - Street 1:2445 4TH AVE S
Practice Address - Street 2:SUITE 112
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1939
Practice Address - Country:US
Practice Address - Phone:206-467-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60022327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist