Healthcare Provider Details

I. General information

NPI: 1942637079
Provider Name (Legal Business Name): KEVIN MICHAEL GELWICH LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30016 45TH AVE S
AUBURN WA
98001-2911
US

IV. Provider business mailing address

30016 45TH AVE S
AUBURN WA
98001-2911
US

V. Phone/Fax

Practice location:
  • Phone: 253-802-6741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60088379
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: