Provider Demographics
NPI:1326202623
Name:MANTZOROS, EMILY JUNE (LMP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JUNE
Last Name:MANTZOROS
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 1:2332 MINOR AVE E
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3333
Mailing Address - Country:US
Mailing Address - Phone:206-714-7432
Mailing Address - Fax:
Practice Address - Street 1:2332 MINOR AVE E
Practice Address - Street 2:SUITE 4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3333
Practice Address - Country:US
Practice Address - Phone:206-714-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60012896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist