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General NPI Number Information
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NPI Number | 1295907509
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Entity Type | Organization
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Legal Business Name | MARTY MATHISON LMP
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 711 LINCOLN AVE
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City | SUNNYSIDE
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State | WA
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Zip | 98944
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Country | US
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Telephone | 509-830-6515
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Fax | 509-837-3876
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Provider Business Mailing Address
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Address Line | 1201 NW CRESCENT RD
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City | SUNNYSIDE
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State | WA
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Zip | 98944
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Country | US
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Telephone | 509-830-6515
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Fax | 509-837-3876
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARTY EUGENE MATHISON
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Credential | LMP
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Telephone | 509-830-6515
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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 | MA00006441
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License Number State | WA
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