Individual
GAVIN LEE FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10575 NE 12TH ST STE 17, BELLEVUE, WA 98004-4362
(425) 296-3385
Mailing address
1106 164TH ST SE APT B302, MILL CREEK, WA 98012-1739
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60767902
WA
Other
Enumeration date
01/13/2018
Last updated
01/13/2018
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