Provider Demographics
NPI:1467733857
Name:MARIO, ERIN (LMP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MARIO
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 1:9144 45TH AVE SW
Mailing Address - Street 2:APT. 7
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2675
Mailing Address - Country:US
Mailing Address - Phone:206-359-1535
Mailing Address - Fax:
Practice Address - Street 1:9144 45TH AVE SW
Practice Address - Street 2:APT. 7
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-2675
Practice Address - Country:US
Practice Address - Phone:206-359-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist