Provider Demographics
NPI:1134674559
Name:AUVIL, MYRIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:MYRIA
Middle Name:
Last Name:AUVIL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MYRIA
Other - Middle Name:AMSLY
Other - Last Name:AUVIL-WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:10608 201ST ST CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338
Mailing Address - Country:US
Mailing Address - Phone:360-850-9578
Mailing Address - Fax:
Practice Address - Street 1:13819 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:360-850-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA60689136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist