Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60468031 | WA |
NPI | 1003297953 |
---|---|
Provider Name | Courtney King |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Newcastle, WA 98059-3136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 10/07/2017 |