Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60026906 | WA |
NPI | 1013168012 |
---|---|
Provider Name | Irma Rivera |
First Address | West Richland, WA 99353-8781 |
Second Address | West Richland, WA 99353-8781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 08/10/2008 |