Provider Demographics
NPI:1033486311
Name:MOUNTER, ELIZABETH JEAN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:MOUNTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 696
Mailing Address - Street 2:
Mailing Address - City:PESHASTIN
Mailing Address - State:WA
Mailing Address - Zip Code:98847
Mailing Address - Country:US
Mailing Address - Phone:509-433-1219
Mailing Address - Fax:
Practice Address - Street 1:9500 PAKASCWA ROAD
Practice Address - Street 2:
Practice Address - City:PESHASTIN
Practice Address - State:WA
Practice Address - Zip Code:98847
Practice Address - Country:US
Practice Address - Phone:509-433-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60253948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist