Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 00013769 | WA |
NPI | 1003587155 |
---|---|
Provider Name | Laurie Anne Swanson |
First Address | Edmonds, WA 98026-8443 |
Second Address | Seattle, WA 98109-2876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2021 |
Last Update Date | 27/09/2021 |