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NPI Code Detail

MEDICARE: MOLLIE BRYAN LMP

MEDICARE:   MOLLIE  BRYAN  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
1225700000XMassage TherapistMA00021339WA

General Provider Information

NPI Number : 1851459119
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLIE BRYAN LMP
Provider Business Mailing Address
First Line : 3026 DONOVAN LOOP SE APT B
Second Line :
City : OLYMPIA
State : WA
Zip : 98501-4888
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2210 BLACK LAKE BLVD SW
Second Line :
City : OLYMPIA
State : WA
Zip : 98512-5604
Country : US
Telephone Number : 360-480-9661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 07/08/2007

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Directions to “ MOLLIE BRYAN LMP” Practice Location

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