MEDICARE: MAYO THERAPY ASSOCIATES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA 00010921	WA

General Provider Information

NPI Number	:	1205086212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYO THERAPY ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	2722 EASTLAKE AVE E STE 360
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3143
Country	:	US
Telephone Number	:	206-324-8600
Fax Number	:	206-322-8520

Provider Business Practice Location Address
First Line	:	2722 EASTLAKE AVE E STE 360
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3143
Country	:	US
Telephone Number	:	206-324-8600
Fax Number	:	206-322-8520

Authorized Official
Title or Position	:	OWNER
Name	:	THERESA MARIE MAYO
Credential	:	LMP
Telephone Number	:	206-769-4505

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	09/26/2008

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