Provider Demographics
NPI:1174017552
Name:ROUGHTON, MARINA GESINE
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:GESINE
Last Name:ROUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 3RD AVE SE APT 717
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3938
Mailing Address - Country:US
Mailing Address - Phone:425-905-0329
Mailing Address - Fax:
Practice Address - Street 1:2902 164TH ST SW STE D1
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-3201
Practice Address - Country:US
Practice Address - Phone:425-745-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist