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General NPI Number Information
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NPI Number | 1164778221
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Entity Type | Organization
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Legal Business Name | MAYA WHOLE HEALTH AT SOUTHPORT
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 1322 LAKE WASHINGTON BLVD N SUITE 3
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City | RENTON
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State | WA
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Zip | 98056-0703
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Country | US
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Telephone | 425-271-0200
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Fax | 206-309-3383
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Provider Business Mailing Address
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Address Line | 1322 LAKE WASHINGTON BLVD N SUITE 3
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City | RENTON
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State | WA
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Zip | 98056-0703
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Country | US
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Telephone | 425-271-0200
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Fax | 206-309-3383
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Authorized Official
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Title or Position | STUDIO COORDINATOR
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Name | MS. WENDY JEAN RAY
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Credential |
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Telephone | 425-271-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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