Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60284629 | WA |
NPI | 1013279181 |
---|---|
Provider Name | Roy Fleisher |
First Address | Kirkland, WA 98034-5529 |
Second Address | Kirkland, WA 98034-5529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 13/06/2012 |