Provider Demographics
NPI:1205086212
Name:MAYO THERAPY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:MAYO THERAPY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-769-4505
Mailing Address - Street 1:2722 EASTLAKE AVE E STE 360
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3143
Mailing Address - Country:US
Mailing Address - Phone:206-324-8600
Mailing Address - Fax:206-322-8520
Practice Address - Street 1:2722 EASTLAKE AVE E STE 360
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3143
Practice Address - Country:US
Practice Address - Phone:206-324-8600
Practice Address - Fax:206-322-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00010921225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty