Provider Demographics
NPI:1447507603
Name:KINTZ, MARIA JOANNE (LMP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOANNE
Last Name:KINTZ
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 1:4613 SE FERNRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9466
Mailing Address - Country:US
Mailing Address - Phone:360-609-4557
Mailing Address - Fax:
Practice Address - Street 1:19206 SE 1ST ST
Practice Address - Street 2:SUITE 118
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7478
Practice Address - Country:US
Practice Address - Phone:360-433-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60305982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist