Provider Demographics
NPI:1255475778
Name:LUND, MARY P (LMP, CNMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:LUND
Suffix:
Gender:F
Credentials:LMP, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E CASINO RD
Mailing Address - Street 2:B16, PMB 5
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2603
Mailing Address - Country:US
Mailing Address - Phone:425-257-0594
Mailing Address - Fax:425-339-2221
Practice Address - Street 1:4323A RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2213
Practice Address - Country:US
Practice Address - Phone:425-355-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011785225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist