Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60405083 | WA |
NPI | 1003244575 |
---|---|
Provider Name | Katherine Dority |
First Address | Yakima, WA 98908-4907 |
Second Address | Yakima, WA 98908-4907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2013 |
Last Update Date | 18/05/2015 |