Provider Demographics
NPI:1508069634
Name:ALBERTUS, MARIAH RAYNE
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:RAYNE
Last Name:ALBERTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18910 BOTHELL EVERETT HWY
Mailing Address - Street 2:UNIT B-3
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5200
Mailing Address - Country:US
Mailing Address - Phone:425-761-5559
Mailing Address - Fax:
Practice Address - Street 1:11404 NE 124TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4305
Practice Address - Country:US
Practice Address - Phone:425-761-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022341225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist