MEDICARE: JOY MICHELLE DERRISO LMT

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	MA60617275	WA

General Provider Information

NPI Number	:	1215156161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY MICHELLE DERRISO LMT

Provider Business Mailing Address
First Line	:	4040 ORCHARD ST W
Second Line	:	SUITE 100
City	:	FIRCREST
State	:	WA
Zip	:	98466-6606
Country	:	US
Telephone Number	:	253-564-1560
Fax Number	:	253-564-4449

Provider Business Practice Location Address
First Line	:	4040 ORCHARD ST W
Second Line	:	SUITE 100
City	:	FIRCREST
State	:	WA
Zip	:	98466-6606
Country	:	US
Telephone Number	:	253-564-1560
Fax Number	:	253-564-4449

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	04/10/2017

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