Provider Demographics
NPI:1396754628
Name:KURTH, MARY ANN (LMPC, CLT)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KURTH
Suffix:
Gender:F
Credentials:LMPC, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28029 197TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8561
Mailing Address - Country:US
Mailing Address - Phone:253-850-8575
Mailing Address - Fax:253-813-5777
Practice Address - Street 1:25403 104TH AVE SE STE 3
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6854
Practice Address - Country:US
Practice Address - Phone:253-850-8575
Practice Address - Fax:253-813-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011295225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist