Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60069118 | WA |
NPI | 1013151844 |
---|---|
Provider Name | Ms. Tasneem T.m. Faruqui-Wildman |
First Address | Renton, WA 98057-2413 |
Second Address | Burien, WA 98168-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 10/06/2016 |