Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | T167337 | CA |
Y | 225700000X | Massage Therapist | MA60717156 | WA |
NPI | 1063957462 |
---|---|
Provider Name | Letitia Stewart |
First Address | Vancouver, WA 98663-2320 |
Second Address | Vancouver, WA 98663-2320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2016 |
Last Update Date | 21/12/2016 |