Provider Demographics
NPI:1851431464
Name:HSU, MARY C (LMP, RBT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:HSU
Suffix:
Gender:F
Credentials:LMP, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24216 CRYSTAL LAKE PL
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-9515
Mailing Address - Country:US
Mailing Address - Phone:425-483-5598
Mailing Address - Fax:
Practice Address - Street 1:18516 101ST AVE NE
Practice Address - Street 2:STE 2
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3882
Practice Address - Country:US
Practice Address - Phone:206-310-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020158225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist