Provider Demographics
NPI:1689823049
Name:BURKE, MARY LOUISE (LMP/MLD/CDT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:BURKE
Suffix:
Gender:F
Credentials:LMP/MLD/CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1656
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0066
Mailing Address - Country:US
Mailing Address - Phone:425-221-5873
Mailing Address - Fax:
Practice Address - Street 1:1818 WESTLAKE AVE N
Practice Address - Street 2:SUITE 414
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2777
Practice Address - Country:US
Practice Address - Phone:206-282-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012872225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist