Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00021790 | WA |
NPI | 1013052034 |
---|---|
Provider Name | Rosa Rene' Sloan |
First Address | Kent, WA 98031-2282 |
Second Address | Kent, WA 98031-2282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 12/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0207295 | LABOR AND INDUSTRIES (01) | WA |
1013052034 | NPPES (01) | WA |