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General NPI Number Information
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NPI Number | 1124113758
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Entity Type | Individual
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Provider Name | WALTER ANTON MOLLER LMP
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 702 LEBO BLVD. SUITE D
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 360-620-4046
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Fax | 360-782-1625
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 11381
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110
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Country | US
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Telephone | 360-620-4046
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Fax | 360-782-1625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00014895
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License Number State | WA
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