Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00018516 | WA |
NPI | 1003026022 |
---|---|
Provider Name | Lily Ilnitsky |
First Address | Federal Way, WA 98003-4946 |
Second Address | Federal Way, WA 98003-5479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |