Provider Demographics
NPI:1245684406
Name:DOOLEY, MICHAEL J (LMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:LMT
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 2162
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-2162
Mailing Address - Country:US
Mailing Address - Phone:509-470-5216
Mailing Address - Fax:
Practice Address - Street 1:101 COTTAGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1078
Practice Address - Country:US
Practice Address - Phone:509-470-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60625116225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist