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General NPI Number Information
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NPI Number | 1932842150
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Entity Type | Individual
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Provider Name | WILLIAM ANTHONY MONTENEGRO
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Gender | Male
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 3773 MARTIN WAY E STE B106
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City | OLYMPIA
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State | WA
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Zip | 98506-5048
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Country | US
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Telephone | 360-356-8896
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 CEDAR CT SE
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City | LACEY
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State | WA
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Zip | 98503-4460
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Country | US
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Telephone |
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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 | MA61283196
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License Number State | WA
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