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General NPI Number Information
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NPI Number | 1467265488
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Entity Type | Individual
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Provider Name | MORGAN COLONY HOUGHTON LMT
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Gender | Male
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2737 77TH AVE SE STE 214
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2832
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Country | US
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Telephone | 206-518-9405
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Fax |
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Provider Business Mailing Address
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Address Line | 25619 SE TIGER MOUNTAIN RD
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City | ISSAQUAH
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State | WA
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Zip | 98027-8357
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Country | US
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Telephone | 206-902-7045
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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 | MA61003219
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License Number State | WA
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