Individual
MR. KELLY MARK BUCHANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
500 S 336TH ST, FEDERAL WAY, WA 98003-6389
(253) 312-2217
Mailing address
500 S 336TH ST STE 110, FEDERAL WAY, WA 98003-6389
(253) 312-2217
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00015776
WA
225700000X
Massage Therapist
MA00015776
WA
Other
Enumeration date
01/05/2007
Last updated
07/22/2021
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