Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60811407 | WA |
NPI | 1003324161 |
---|---|
Provider Name | Sophia Alfred |
First Address | Seattle, WA 98125-4908 |
Second Address | Seattle, WA 98115-6724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 11/01/2018 |