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NPI Code Detail

MEDICARE: MARY E BURRIS LMT

MEDICARE:   MARY E BURRIS  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
1225700000XMassage Therapist26399OR

General Provider Information

NPI Number : 1932877206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E BURRIS LMT
Provider Business Mailing Address
First Line : 2155 W FIRESTONE LN UNIT 16
Second Line :
City : VANCOUVER
State : WA
Zip : 98660-1188
Country : US
Telephone Number : 360-601-4246
Fax Number :
Provider Business Practice Location Address
First Line : 2155 W FIRESTONE LN
Second Line :
City : VANCOUVER
State : WA
Zip : 98660-1186
Country : US
Telephone Number : 360-601-4246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2021
Last Update Date : 09/01/2021

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Directions to “ MARY E BURRIS LMT” Practice Location

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