Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60579464 | WA |
NPI | 1013385590 |
---|---|
Provider Name | John Postlewaite |
First Address | Sammamish, WA 98074-9349 |
Second Address | Sammamish, WA 98074-9349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2015 |
Last Update Date | 14/09/2015 |