Provider Demographics
NPI:1467674184
Name:ROBSAHM, MARY M (MED, LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:ROBSAHM
Suffix:
Gender:F
Credentials:MED, LMP
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:ROBSAHM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LMP
Mailing Address - Street 1:17470 136TH PL SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9734
Mailing Address - Country:US
Mailing Address - Phone:425-422-8455
Mailing Address - Fax:360-794-7492
Practice Address - Street 1:404 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2315
Practice Address - Country:US
Practice Address - Phone:425-422-8455
Practice Address - Fax:360-794-7492
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist