Provider Demographics
NPI:1285385559
Name:CORONA, MARCY (LMT)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 NE 182ND ST UNIT D503
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-5008
Mailing Address - Country:US
Mailing Address - Phone:619-382-5064
Mailing Address - Fax:
Practice Address - Street 1:6711 NE 182ND ST UNIT D503
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-5008
Practice Address - Country:US
Practice Address - Phone:619-382-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61230805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist