is a Massage Therapist in Clearlake, Washington. practices all healthcare services and medical treatments related to Massage Therapist. The NPI Number for is 1497965925. The last update date is .
's current location address is 12263 North Mill Street, Clearlake, Washington. You can contact this provider via phone number 3608565354. The mailing address for is 12263 North Mill Street, Clearlake, Washington. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 12263 North Mill Street, Clearlake, Washington |
| Phone Number | 3608565354 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1497965925 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 12263 North Mill Street |
|---|---|
| City | Clearlake |
| State | Washington (WA) |
| Post Code | 98235 |
| Phone Number | 3608565354 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Massage Therapist |
|---|---|
| Taxonomy | 225700000X |
| Licence No | MA00010617 |
|
Definition: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 115508 | WA | LABOR AND INDUSTRIES |
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