Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60817462 | WA |
NPI | 1003392572 |
---|---|
Provider Name | Mr. Eugene Jeffrey Mullens JR. |
First Address | Federal Way, WA 98003-7070 |
Second Address | Federal Way, WA 98003-7070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 17/07/2018 |