Provider Demographics
NPI:1215122197
Name:MASTBERG, ROSE KATHERYNE (LMP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:KATHERYNE
Last Name:MASTBERG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
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Mailing Address - Street 1:6619 132ND AVE NE
Mailing Address - Street 2:#163
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-882-9065
Mailing Address - Fax:425-558-1900
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-882-9065
Practice Address - Fax:425-558-1900
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00021110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist