Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60484292 | WA |
NPI | 1013323930 |
---|---|
Provider Name | Stephanie Macphail |
First Address | Maple Valley, WA 98038 |
Second Address | Maple Valley, WA 98038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2014 |
Last Update Date | 11/07/2014 |