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General NPI Number Information
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NPI Number | 1316288566
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Entity Type | Individual
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Provider Name | RONALD GLENN COLYER JR. L.M.P.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 160 CASCADE PL SUITE 106
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City | BURLINGTON
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State | WA
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Zip | 98233-3126
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Country | US
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Telephone | 360-941-4243
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Fax |
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Provider Business Mailing Address
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Address Line | 17771 DUNBAR RD
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City | MOUNT VERNON
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State | WA
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Zip | 98273-8751
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Country | US
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Telephone | 425-466-3140
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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 | MA60331538
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License Number State | WA
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