Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00024629 | WA |
NPI | 1003003138 |
---|---|
Provider Name | Tricia L Johnson-Fenter |
First Address | Snohomish, WA 98291-0946 |
Second Address | Snohomish, WA 98290-2942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 02/10/2007 |