Provider Demographics
NPI:1144513383
Name:GAPUZ, MICHAEL MARK A (LMP)
Entity type:Individual
Prefix:
First Name:MICHAEL MARK
Middle Name:A
Last Name:GAPUZ
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 SE 267TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7179
Mailing Address - Country:US
Mailing Address - Phone:253-854-7163
Mailing Address - Fax:
Practice Address - Street 1:11220 SE 267TH PL
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7179
Practice Address - Country:US
Practice Address - Phone:253-854-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60222470225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist