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General NPI Number Information
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NPI Number | 1245748383
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Entity Type | Individual
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Provider Name | MATTHEW FREDERICK WYSOCKI
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Gender | Male
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 5118 BOSWORTH DR
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City | SNOHOMISH
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State | WA
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Zip | 98290-7700
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Country | US
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Telephone | 520-260-3458
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 629
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City | GRANITE FALLS
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State | WA
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Zip | 98252-0629
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Country | US
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Telephone | 520-260-3458
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Fax |
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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 |
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License Number State |
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