Provider Demographics
NPI:1619675972
Name:BURKETT, MARIAH (LMT)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:BURKETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARS
Other - Middle Name:
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:3629 139TH ST NW
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-7106
Mailing Address - Country:US
Mailing Address - Phone:425-563-5446
Mailing Address - Fax:
Practice Address - Street 1:3710 168TH ST NE STE A102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8462
Practice Address - Country:US
Practice Address - Phone:971-328-1293
Practice Address - Fax:360-844-1839
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61406077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist