Individual ProviderLinda PhimmavongMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address7308 Bridgeport Way W, Ste. 103, Lakewood, WA 98499-8000(253) 582-8142(253) 564-1560PECOS EnrollmentBased on the most recent information from CMS, provider Linda Phimmavong does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:51 AM.Profile DetailsProvider ID1124493440Provider TypeIndividualFull NamePhimmavong, LindaCredentialLMPGenderFemaleSole ProprietorNoEnumeration Date12/11/2015Last Updated12/11/2015Contact InformationPractice LocationPractice Address7308 Bridgeport Way W, Ste. 103, Lakewood, WA 98499-8000Phone(253) 582-8142Fax(253) 582-8160Mailing LocationMailing Address4040 Orchard St W, Ste. 100, Fircrest, WA 98466-6606Phone(253) 564-1560Fax(253) 564-4449Provider TaxonomiesCodeDescriptionLicenseCode225700000XPrimaryDescriptionMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseMA60590721Washington