MEDICARE: KENDALL MATHEW 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	MA60390830	WA

General Provider Information

NPI Number	:	1700215654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL MATHEW LMP

Provider Business Mailing Address
First Line	:	28129 239TH PL SE
Second Line	:
City	:	MAPLE VALLEY
State	:	WA
Zip	:	98038-5123
Country	:	US
Telephone Number	:	425-432-4787
Fax Number	:

Provider Business Practice Location Address
First Line	:	28129 239TH PL SE
Second Line	:
City	:	MAPLE VALLEY
State	:	WA
Zip	:	98038-5123
Country	:	US
Telephone Number	:	425-432-4787
Fax Number	:

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

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	11/01/2013

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Directions to “ KENDALL MATHEW LMP” Practice Location

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