Wallace, Kenneth Mark

Wallace, Kenneth Mark is an sole proprietor health care provider with primary practice located at 4004 89Th Ave Se , Mercer Island WA 98040-4102. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist, which is considered as his primary health care specialty. Wallace, Kenneth Mark can be contacted via phone (206) 396-8452.

Contact Information

Primary practice address
4004 89Th Ave Se Mercer Island WA 98040-4102
Phone: (206) 396-8452
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist 225700000X MA60197801 Washington

Profile Details

NPI number 1346548708
LBN Legal business name Wallace, Kenneth Mark
Credentials LMP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 9th, 2011
Last updated Mar 29th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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