Provider Demographics
NPI:1578031332
Name:GALVAN PEREZ, MARIA I (MASSAGE THERAPY)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GALVAN PEREZ
Suffix:I
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:GALVAN PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSAGE THERAPY
Mailing Address - Street 1:16627 36TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7003
Mailing Address - Country:US
Mailing Address - Phone:425-399-3345
Mailing Address - Fax:
Practice Address - Street 1:3910 196TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5770
Practice Address - Country:US
Practice Address - Phone:425-399-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60898187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60898187OtherMASSAGE THERAPY LICENCE