Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60947935 | WA |
NPI | 1013570043 |
---|---|
Provider Name | Katreena M Hallberg |
First Address | Eatonville, WA 98328-1674 |
Second Address | Eatonville, WA 98328-9832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2019 |
Last Update Date | 16/04/2019 |