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Individual
MATTHEW JOHN MIRELEZ
Active
Individual
MATTHEW JOHN MIRELEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60780186
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA60780186
MASSAGE LICENSE
WA
Enumeration date
08/02/2017
Last updated
08/02/2017
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