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General NPI Number Information
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NPI Number | 1417257577
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Entity Type | Individual
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Provider Name | DOUG MCCREARY LMP
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Gender | Male
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 906 E JOHN ST #202
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City | SEATTLE
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State | WA
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Zip | 98102-6400
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Country | US
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Telephone | 206-778-3684
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Fax |
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Provider Business Mailing Address
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Address Line | 521 NW 196TH PL
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City | SHORELINE
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State | WA
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Zip | 98177-2543
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Country | US
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Telephone | 206-778-3684
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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 | MA60115085
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License Number State | WA
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