Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60483810 | WA |
NPI | 1003468000 |
---|---|
Provider Name | Destiny V Scott |
First Address | Seattle, WA 98108-2436 |
Second Address | Seattle, WA 98108-2436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2019 |
Last Update Date | 10/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60483810 | LMT (01) | WA |