Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA61179279 | WA |
NPI | 1003582396 |
---|---|
Provider Name | Karen Jill Ryan |
First Address | Mabton, WA 98935 |
Second Address | Sunnyside, WA 98944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |