MEDICARE: MARIE GLENNON LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00024937	WA

General Provider Information

NPI Number	:	1073776621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE GLENNON LMP

Provider Business Mailing Address
First Line	:	4616 25TH AVE NE # 352
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4183
Country	:	US
Telephone Number	:	206-395-6733
Fax Number	:

Provider Business Practice Location Address
First Line	:	5234 50TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-2813
Country	:	US
Telephone Number	:	206-395-6733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	09/11/2014

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Directions to “ MARIE GLENNON LMP” Practice Location

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