Provider Demographics
NPI:1518459379
Name:STETSON, MARK (LMT, CSCS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:STETSON
Suffix:
Gender:M
Credentials:LMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15436 BEL RED RD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5536
Mailing Address - Country:US
Mailing Address - Phone:425-274-3430
Mailing Address - Fax:206-267-0814
Practice Address - Street 1:15436 BEL RED RD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5536
Practice Address - Country:US
Practice Address - Phone:425-274-3430
Practice Address - Fax:206-267-0814
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60864206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist