Healthcare Provider Details

I. General information

NPI: 1932565249
Provider Name (Legal Business Name): K'MARON MARKSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 100TH ST SW STE B
LAKEWOOD WA
98499-2710
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 253-284-9800
  • Fax:
Mailing address:
  • Phone: 630-296-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60614114
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: