Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60806961 | WA |
NPI | 1003321852 |
---|---|
Provider Name | Jonathon Dustin Kocher |
First Address | Tacoma, WA 98405-4150 |
Second Address | Tacoma, WA 98405-4150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2017 |
Last Update Date | 01/12/2017 |