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NPI Code Detail

MEDICARE: MARRISA BISSONNETTE LMT, CR

MEDICARE:   MARRISA  BISSONNETTE  LMT, CR
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
1225700000XMassage TherapistMA60042660WA

General Provider Information

NPI Number : 1609006774
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARRISA BISSONNETTE LMT, CR
Provider Business Mailing Address
First Line : 501 E MCLOUGHLIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3356
Country : US
Telephone Number : 360-831-3834
Fax Number :
Provider Business Practice Location Address
First Line : 501 E MCLOUGHLIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3356
Country : US
Telephone Number : 360-831-3834
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2009
Last Update Date : 04/12/2024

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Directions to “ MARRISA BISSONNETTE LMT, CR” Practice Location

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