Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00024091 | WA |
NPI | 1003179102 |
---|---|
Provider Name | Diane Garris |
First Address | Lynnwood, WA 98037-6401 |
Second Address | Lynnwood, WA 98037-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 09/03/2015 |