Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00009262 | WA |
NPI | 1013042381 |
---|---|
Provider Name | Mrs. Judy Lee Wendt |
First Address | Pullman, WA 99163-2611 |
Second Address | Pullman, WA 99163-2611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |