Provider Demographics
NPI:1215528211
Name:TATE, MARY (LMT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:8309 E LACROSSE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212
Mailing Address - Country:US
Mailing Address - Phone:509-251-7393
Mailing Address - Fax:
Practice Address - Street 1:8817 E MISSION AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-5034
Practice Address - Country:US
Practice Address - Phone:509-928-1400
Practice Address - Fax:509-927-3034
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61136768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist