Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00012347 | WA |
N | 225700000X | Massage Therapist | MA12347 | WA |
NPI | 1003974650 |
---|---|
Provider Name | Sonya C Grace |
First Address | Kenmore, WA 98028 |
Second Address | Kenmore, WA 98028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 22/06/2016 |