Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60135072 | WA |
NPI | 1003127127 |
---|---|
Provider Name | Alisa Burggrabe-Brossia |
First Address | Vancouver, WA 98664-2010 |
Second Address | Vancouver, WA 98664-2010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 24/01/2011 |