Provider Demographics
NPI:1487949012
Name:VANARIA, MARY B (LMP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:VANARIA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LACOCK KELCHNER RD
Mailing Address - Street 2:
Mailing Address - City:UNDERWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98651-9227
Mailing Address - Country:US
Mailing Address - Phone:509-493-1235
Mailing Address - Fax:
Practice Address - Street 1:32 LACOCK KELCHNER RD
Practice Address - Street 2:
Practice Address - City:UNDERWOOD
Practice Address - State:WA
Practice Address - Zip Code:98651-9227
Practice Address - Country:US
Practice Address - Phone:509-493-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007132172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist