MEDICARE: LI PAN

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	MA61029851	WA

General Provider Information

NPI Number	:	1750256467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LI PAN

Provider Business Mailing Address
First Line	:	1206 STATE AVE STE H
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-3645
Country	:	US
Telephone Number	:	425-903-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 STATE AVE STE H
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-3645
Country	:	US
Telephone Number	:	425-903-1516
Fax Number	:

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

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	10/24/2025

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Directions to “ LI PAN ” Practice Location

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