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Individual

DICK DUANE POULIOT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMP

Contact information

Practice address
1818 GROVE ST # A, MARYSVILLE, WA 98270-4330
(425) 280-1008
Mailing address
10218 60TH ST SE, SNOHOMISH, WA 98290-1016
(425) 280-1008

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M00004930
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
54890
L&I NUMBER
WA
01
PO9881
REGENCE BLUE SHIELD NUM.
WA
Enumeration date
02/14/2007
Last updated
07/08/2007
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