Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60730245 | WA |
NPI | 1013446483 |
---|---|
Provider Name | Imani Joy Pyatt |
First Address | Pearland, TX 77584-2390 |
Second Address | Seattle, WA 98134-1820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 08/06/2017 |