Healthcare Provider Details

I. General information

NPI: 1053683052
Provider Name (Legal Business Name): LIVING MEDICAL ARTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10516 E RIVERSIDE DR
BOTHELL WA
98011-3714
US

IV. Provider business mailing address

10516 E RIVERSIDE DR
BOTHELL WA
98011-3714
US

V. Phone/Fax

Practice location:
  • Phone: 425-949-7018
  • Fax:
Mailing address:
  • Phone: 425-949-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60188651
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00023350
License Number StateWA

VIII. Authorized Official

Name: DR. MANDY RAE GULLA
Title or Position: MEMBER
Credential: ND LMT CM
Phone: 425-949-7018