Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00016009 | WA |
NPI | 1013137983 |
---|---|
Provider Name | Mrs. Sofe Silverman |
First Address | Lakewood, WA 98498-4868 |
Second Address | University Place, WA 98466-4632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 20/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA00016009 | WA STATE MASSAGE LICENSE (01) | WA |