Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60943549 | WA |
NPI | 1003439282 |
---|---|
Provider Name | Maivnkauj Zoe Goertzen |
First Address | Spokane Valley, WA 99216-5083 |
Second Address | Spokane Valley, WA 99216-5083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2020 |
Last Update Date | 22/05/2020 |