Provider Demographics
NPI:1417556598
Name:SIU, MARIO JHONEAL (LMT)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:JHONEAL
Last Name:SIU
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 EASTLAKE AVE E STE 360
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3143
Mailing Address - Country:US
Mailing Address - Phone:206-324-8600
Mailing Address - Fax:
Practice Address - Street 1:2722 EASTLAKE AVE E
Practice Address - Street 2:SUITE # 360
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-324-8600
Practice Address - Fax:206-322-8520
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1333881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist