Healthcare Provider Details

I. General information

NPI: 1023211984
Provider Name (Legal Business Name): THE J.W. MARINO CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S 312TH ST SUITE 202
FEDERAL WAY WA
98003-9028
US

IV. Provider business mailing address

1305 S 312TH ST SUITE 202
FEDERAL WAY WA
98003-9028
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-2000
  • Fax: 253-946-8888
Mailing address:
  • Phone: 253-946-2000
  • Fax: 253-946-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JAMES W MARINO
Title or Position: PRESIDENT
Credential:
Phone: 253-946-2000