Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00017859 | WA |
NPI | 1003160698 |
---|---|
Provider Name | Lisa Marie King |
First Address | Friday Harbor, WA 98250-1763 |
Second Address | Friday Harbor, WA 98250-8057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2012 |
Last Update Date | 03/11/2012 |