Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 00019328 | WA |
NPI | 1003275991 |
---|---|
Provider Name | Mr. William Brian Kingsford |
First Address | Kirkland, WA 98033-8571 |
Second Address | Kirkland, WA 98033-8571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2016 |
Last Update Date | 01/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841340064 | CHIROPRACTIC AND MASSAGE (01) | WA |