Provider Demographics
NPI:1275347080
Name:JUNEAU, MARC BERNARD (MA61414110)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:BERNARD
Last Name:JUNEAU
Suffix:
Gender:M
Credentials:MA61414110
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9423
Mailing Address - Country:US
Mailing Address - Phone:720-614-9847
Mailing Address - Fax:
Practice Address - Street 1:1705 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9423
Practice Address - Country:US
Practice Address - Phone:720-614-9847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61414110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist