Kenneth Mark Wallace, LMP Valid NPI

Individual provider · Massage Therapist · Mercer Island, WA

NPI

1346548708

Type

Individual (Type 1)

Primary specialty

Massage Therapist

Specialty group

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy code

225700000X

License number

MA60197801 (WA)

Sex

Male

Sole proprietor

Yes

Enumerated

2011-03-09

Last updated

2011-03-29