Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60355700 | WA |
NPI | 1003244088 |
---|---|
Provider Name | Tranecia Celestine |
First Address | Puyallup, WA 98375-6242 |
Second Address | Puyallup, WA 98374-8848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2013 |
Last Update Date | 29/10/2013 |