Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003345653 |
---|---|
Provider Name | Elizabeth May Jones |
First Address | Maple Valley, WA 98038-8222 |
Second Address | Maple Valley, WA 98038-8222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000000000000000000 | DONT HAVE ONE (01) | |
00000000000000000000 | NONE YET (01) |