Provider Demographics
NPI:1437391919
Name:MAVROS, ANTHONY LOUIS (LPM, MMP, NCTM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LOUIS
Last Name:MAVROS
Suffix:
Gender:M
Credentials:LPM, MMP, NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7322 NE 140TH PL
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5306
Mailing Address - Country:US
Mailing Address - Phone:425-205-9893
Mailing Address - Fax:
Practice Address - Street 1:14500 JUANITA DR NE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4966
Practice Address - Country:US
Practice Address - Phone:425-205-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist