Healthcare Provider Details

I. General information

NPI: 1871009407
Provider Name (Legal Business Name): MARY ANN BEBERMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 WOODCHUCK LN SE
PORT ORCHARD WA
98367-8280
US

IV. Provider business mailing address

11111 WOODCHUCK LN SE
PORT ORCHARD WA
98367-8280
US

V. Phone/Fax

Practice location:
  • Phone: 360-621-5578
  • Fax:
Mailing address:
  • Phone: 360-621-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60819626
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: