Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60973322 | WA |
NPI | 1003477761 |
---|---|
Provider Name | Dominique Devine |
First Address | Tacoma, WA 98409-6828 |
Second Address | Puyallup, WA 98372-4691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 24/06/2019 |