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NPI Code Detail

MEDICARE: ELTON RAY BUSBY LMP

MEDICARE: ELTON RAY BUSBY 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
1225700000XMassage TherapistMA60493610WA

General Provider Information

NPI Number : 1184023988
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELTON RAY BUSBY LMP
Provider Business Mailing Address
First Line : 7700 PIONEER WAY
Second Line : SUITE 101
City : GIG HARBOR
State : WA
Zip : 98335-1156
Country : US
Telephone Number : 253-509-0258
Fax Number :
Provider Business Practice Location Address
First Line : 7700 PIONEER WAY
Second Line : SUITE 101
City : GIG HARBOR
State : WA
Zip : 98335-1156
Country : US
Telephone Number : 253-509-0258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2014
Last Update Date : 12/10/2015

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