Provider Demographics
NPI:1588783906
Name:THIBERT, MARJORIE MICHELLE (LMP)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:MICHELLE
Last Name:THIBERT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4940 N VISTA DR E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8609
Mailing Address - Country:US
Mailing Address - Phone:253-221-7312
Mailing Address - Fax:253-862-6254
Practice Address - Street 1:1837 COLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3555
Practice Address - Country:US
Practice Address - Phone:253-221-7312
Practice Address - Fax:253-862-6254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist