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General NPI Number Information
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NPI Number | 1417773862
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Entity Type | Individual
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Provider Name | MARIO A PURIN LMT, RMA, NCPT3
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Gender | Male
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 761 SW CASTILIAN DR
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City | OAK HARBOR
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State | WA
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Zip | 98277-4529
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Country | US
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Telephone | 360-682-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 3608 N PRINCE ST STE C303
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City | CLOVIS
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State | NM
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Zip | 88101-2105
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Country | US
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Telephone | 360-682-9990
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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 | MA00007896
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License Number State | WA
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