MEDICARE: PHOENIX MIEARS 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	MA61201701	WA

General Provider Information

NPI Number	:	1871253831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHOENIX MIEARS LMT

Provider Business Mailing Address
First Line	:	10620 66TH AVE NE
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-8323
Country	:	US
Telephone Number	:	425-789-4611
Fax Number	:

Provider Business Practice Location Address
First Line	:	4423 S 3RD AVE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-2515
Country	:	US
Telephone Number	:	425-789-4611
Fax Number	:

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

Provider Enumeration Date	:	12/17/2021
Last Update Date	:	09/02/2022

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Directions to “ PHOENIX MIEARS LMT” Practice Location

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