Most Relevant Information
Provider Data
| NPI Number: | 1003470154 |
| Provider Name: | BRIAN JAMES PETRICH LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | MA60936482 |
Most Important Dates
| Enumeration Date: | 04/24/2019 |
| Last Updated: | 04/24/2019 |
Provider Practice Location
1963 BETHEL RD SE
PORT ORCHARD
WA
983663108
Practice Location Phone/Fax
| Phone: | 2538615297 |
| Fax: |
Provider Mailing Location
15769 SUNNY COVE DR SE
OLALLA
WA
983599594
Provider Mailing Phone/Fax
| Phone: | 2538615297 |
| Fax: |