Healthcare Provider Details

I. General information

NPI: 1285850859
Provider Name (Legal Business Name): GARY SCOTT WURTZ LMP RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 12TH AVE NE
SEATTLE WA
98115-6753
US

IV. Provider business mailing address

6515 12TH AVE NE
SEATTLE WA
98115-6753
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-5511
  • Fax: 206-829-8415
Mailing address:
  • Phone: 206-524-5511
  • Fax: 206-829-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: