MEDICARE: JUDITH MARIE VISSER LMP

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	MA60173733	WA

General Provider Information

NPI Number	:	1457654402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH MARIE VISSER LMP

Provider Business Mailing Address
First Line	:	1212 E CHICAGO ST
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98030-6263
Country	:	US
Telephone Number	:	253-850-2886
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 E CHICAGO ST
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98030-6263
Country	:	US
Telephone Number	:	253-850-2886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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Directions to “ JUDITH MARIE VISSER LMP” Practice Location

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