Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00004525 | WA |
NPI | 1003323213 |
---|---|
Provider Name | Kimberly Lynn Mowery-Reams |
First Address | Puyallup, WA 98373-2405 |
Second Address | Puyallup, WA 98373-2405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 09/10/2018 |