Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00004681 | WA |
NPI | 1013146273 |
---|---|
Provider Name | Teresa L. Cook |
First Address | Yakima, WA 98908-4319 |
Second Address | Yakima, WA 98908-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 09/07/2009 |