Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00019446 | WA |
NPI | 1003343914 |
---|---|
Provider Name | Sara Anne Shelton |
First Address | Tacoma, WA 98404-2930 |
Second Address | Tacoma, WA 98404-2930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 23/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA00019447 | MASSAGE THERAPIST (01) | WA |