Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00025299 | WA |
NPI | 1003079724 |
---|---|
Provider Name | Mr. Bernard Anthony Smith |
First Address | Auburn, WA 98092-7291 |
Second Address | Auburn, WA 98092-7291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |