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General NPI Number Information
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NPI Number | 1659197721
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Entity Type | Individual
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Provider Name | MARIAH GALLUP LMT
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Gender | Female
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 13701 E SPRAGUE AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-0811
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Country | US
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Telephone | 509-590-0156
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 N ALTAMONT ST
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City | SPOKANE
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State | WA
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Zip | 99217-5002
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Country | US
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Telephone | 509-496-7079
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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 | MA61627549
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License Number State | WA
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