Provider Demographics
NPI:1346525078
Name:MATULIS, MEGAN (LAC, AEMP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MATULIS
Suffix:
Gender:F
Credentials:LAC, AEMP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:L
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 14425
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99214-0425
Mailing Address - Country:US
Mailing Address - Phone:509-240-9339
Mailing Address - Fax:509-282-5663
Practice Address - Street 1:909 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4932
Practice Address - Country:US
Practice Address - Phone:509-240-9339
Practice Address - Fax:509-282-5663
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61020738171100000X
WAMA60252300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist