Provider Demographics
NPI:1568256881
Name:MAYLE, MATTHEW (LMT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MAYLE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:GRINSTEAD-MAYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 E JEWETT BLVD # 419
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-3000
Mailing Address - Country:US
Mailing Address - Phone:614-573-6424
Mailing Address - Fax:
Practice Address - Street 1:220 E JEWETT BLVD # 419
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-3000
Practice Address - Country:US
Practice Address - Phone:614-573-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61493988225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist