Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA61082905 | WA |
NPI | 1003429291 |
---|---|
Provider Name | Jill Rupp |
First Address | Renton, WA 98056-1455 |
Second Address | Renton, WA 98056-1455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 26/08/2020 |