Provider Demographics
NPI:1952435547
Name:MAYO, THERESA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:MAYO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:GIBBONS
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:3302 FUHRMAN AVE E STE 110
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-7115
Mailing Address - Country:US
Mailing Address - Phone:206-402-4012
Mailing Address - Fax:206-588-0795
Practice Address - Street 1:3302 FUHRMAN AVE E STE 110
Practice Address - Street 2:SUITE 110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-7115
Practice Address - Country:US
Practice Address - Phone:206-402-4012
Practice Address - Fax:206-588-0795
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010921225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist