Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00006600 | WA |
NPI | 1013227339 |
---|---|
Provider Name | Christine Davis |
First Address | Port Orchard, WA 98366 |
Second Address | Port Orchard, WA 98366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2010 |
Last Update Date | 20/10/2010 |