Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00018434 | WA |
NPI | 1003004516 |
---|---|
Provider Name | Ms. Terri Lynn Moore |
First Address | Auburn, WA 98002-1312 |
Second Address | Auburn, WA 98002-1312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 09/10/2007 |