Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60240337 | WA |
NPI | 1013290238 |
---|---|
Provider Name | Yukako Izawa |
First Address | Everett, WA 98204-1581 |
Second Address | Everett, WA 98204-1581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2011 |
Last Update Date | 23/09/2011 |