Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60113267 | WA |
NPI | 1013213792 |
---|---|
Provider Name | Jeffrey Wright |
First Address | Kirkland, WA 98034-9028 |
Second Address | Kirkland, WA 98034-9028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2011 |
Last Update Date | 28/01/2011 |