Provider Demographics
NPI:1265502249
Name:LUKE, MARCI (MT)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:LUKE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14575 BEL RED RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3908
Mailing Address - Country:US
Mailing Address - Phone:425-641-8052
Mailing Address - Fax:425-641-8053
Practice Address - Street 1:14575 BEL-RED RD STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3908
Practice Address - Country:US
Practice Address - Phone:425-641-8052
Practice Address - Fax:425-641-8053
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist