MEDICARE: CHERIE DUBEAU 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	MA 60146601	WA

General Provider Information

NPI Number	:	1679890982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERIE DUBEAU LMP

Provider Business Mailing Address
First Line	:	4406 W LAKE SAMMAMISH PKWY SE
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-9774
Country	:	US
Telephone Number	:	360-941-1615
Fax Number	:	425-643-9170

Provider Business Practice Location Address
First Line	:	4406 W LAKE SAMMAMISH PKWY SE
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-9774
Country	:	US
Telephone Number	:	360-941-1615
Fax Number	:	425-643-9170

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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Directions to “ CHERIE DUBEAU LMP” Practice Location

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