Individual
MARISA SEANA WENTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
307 S 12TH AVE STE 9, YAKIMA, WA 98902-3138
(360) 580-4215
Mailing address
14511 MCAULEY RD, YAKIMA, WA 98908-9134
(360) 580-4215
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA60315675
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0316475
LABOR & INDUSTRIES
WA
Enumeration date
01/26/2017
Last updated
07/07/2020
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