Healthcare Provider Details

I. General information

NPI: 1508688771
Provider Name (Legal Business Name): MICHAEL MITCHELL LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 N BEACH RD
EASTSOUND WA
98245-8927
US

IV. Provider business mailing address

218 SEAVIEW ST
EASTSOUND WA
98245-9655
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-4002
  • Fax:
Mailing address:
  • Phone: 360-298-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00013465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: