Provider Demographics
NPI:1710307442
Name:MAUPOUX, MARC (LMP)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MAUPOUX
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 BELMONT AVE E APT 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-6006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1523 E MADISON ST
Practice Address - Street 2:STE 7
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4013
Practice Address - Country:US
Practice Address - Phone:206-491-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60403982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist