Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 00023883 | WA |
NPI | 1003064742 |
---|---|
Provider Name | Corina Griffith |
First Address | Redmond, WA 98053-2107 |
Second Address | Redmond, WA 98053-2107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2008 |
Last Update Date | 06/09/2008 |