Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60530986 | WA |
NPI | 1003273426 |
---|---|
Provider Name | Robert Lewis |
First Address | Seattle, WA 98107-5264 |
Second Address | Seattle, WA 98107-5264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2016 |
Last Update Date | 19/01/2016 |