Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60322273 | WA |
NPI | 1003258989 |
---|---|
Provider Name | Ms. Suzanna Gale Lester |
First Address | Tukwila, WA 98188 |
Second Address | Tukwila, WA 98188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 22/07/2013 |