Healthcare Provider Details

I. General information

NPI: 1457569956
Provider Name (Legal Business Name): MARY JO DIGESU BARTHOLOMEW LICENSED MASSAGE THE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9349 E LEAVENWORTH RD
LEAVENWORTH WA
98826
US

IV. Provider business mailing address

9349 E LEAVENWORTH RD
LEAVENWORTH WA
98826
US

V. Phone/Fax

Practice location:
  • Phone: 509-782-1251
  • Fax:
Mailing address:
  • Phone: 509-548-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00012209
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: