Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60059245 | WA |
NPI | 1003106238 |
---|---|
Provider Name | Tiffany Haak |
First Address | Yakima, WA 98908 |
Second Address | Yakima, WA 98908-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 08/04/2011 |