Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60464289 | WA |
NPI | 1003413048 |
---|---|
Provider Name | Izumi Y Masaki |
First Address | Everett, WA 98204-2715 |
Second Address | Bellevue, WA 98005-9800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2020 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA60464289 | WASHINGTON STATE DEPARTMENT OF HEALTH (01) | WA |