Provider Demographics
NPI:1235674300
Name:MARIE, ANITA (LMP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MARIE
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 1:51 W DAYTON ST
Mailing Address - Street 2:#304
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 W DAYTON ST
Practice Address - Street 2:#304
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4111
Practice Address - Country:US
Practice Address - Phone:425-582-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60655910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist