MEDICARE: SAMANTHA DART LMT

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	MA60502620	WA

General Provider Information

NPI Number	:	1821546789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DART LMT

Provider Business Mailing Address
First Line	:	3150 W MAPLEWOOD AVE
Second Line	:	#104
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1080
Country	:	US
Telephone Number	:	425-802-6651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 CAROLINA ST
Second Line	:	D12
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-5487
Country	:	US
Telephone Number	:	425-802-6651
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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Directions to “ SAMANTHA DART LMT” Practice Location

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