Provider Demographics
NPI:1114221009
Name:GARRY, MATT (LMP)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:GARRY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 27TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5212
Mailing Address - Country:US
Mailing Address - Phone:253-212-2732
Mailing Address - Fax:253-212-2732
Practice Address - Street 1:6808 27TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5212
Practice Address - Country:US
Practice Address - Phone:253-212-2732
Practice Address - Fax:253-212-2732
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60203481225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist