Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60524194 | WA |
NPI | 1003484023 |
---|---|
Provider Name | Ronda Kay Knebel |
First Address | Kent, WA 98030-4759 |
Second Address | Kent, WA 98030-7919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/06/2021 |