Mary Ann Miller, LMP

Individual provider Active NPI Massage Therapist · Soap Lake, WA

NPI 1295859130 · NPPES record last updated Jul 3, 2008

Key facts

NPI
1295859130
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
MA00016970 (WA)
Practice address
318 Main Avenue East
Soap Lake, WA 98851
Phone
(509) 246-1660
Fax
(509) 246-1660
NPI assigned
Mar 17, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
MA00016970WAMDMassage Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA00016970 WA Yes

Addresses

Primary practice location

318 Main Avenue East
Soap Lake, WA 98851

Mailing address

PO Box 1267
Ephrata, WA 98823-1699
Phone (360) 286-8151

Other identifiers

IdentifierTypeStateIssuer
204320615OtherWAAXIA HEALTH NETWORK

Other providers in Soap Lake, WA

All providers in Soap Lake, WA · Massage Therapist in Washington

Sources for this page

Verify at the official NPI Registry.