Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00023036 | WA |
NPI | 1013148287 |
---|---|
Provider Name | Stephanie Heringer |
First Address | Brier, WA 98036-8278 |
Second Address | Mukilteo, WA 98275-2653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 05/08/2009 |