Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00024064 | WA |
NPI | 1003000183 |
---|---|
Provider Name | Mr. Dennis James Cyphers |
First Address | Tacoma, WA 98467-3207 |
Second Address | Tacoma, WA 98467-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 30/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPT 97124 | LABOR & INDUSTRIES (01) | WA |