MR. Kenneth Mark Wallace JR., LMP
NPI #1346548708 in Mercer Island, Washington
Provider Information
- NPI Number
- 1346548708
- Entity Type
- Individual
- Name
- MR. Kenneth Mark Wallace JR., LMP
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Massage Therapist
- Credential
- LMP
- Enumeration Date
- Mar 9, 2011
- Last Updated
- Mar 29, 2011
Practice Location
- Address
- 4004 89TH AVE SE
- City
- Mercer Island
- State
- Washington
- ZIP Code
- 98040-4102
- Phone
- (206) 396-8452
Specialties & Taxonomy Codes
| Specialty |
|---|
| Massage Therapist |
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